OUT-OF-SEASON

PHYSICAL CONDITIONING/OPEN GYM PARTICIPATION FORM

I, AS A PARENT/GUARDIAN, UNDERSTAND THAT Liberty High School will occasionally make available optional supervised Open Gym/Field/ and/or Out-of-Season conditioning programs for all students. Participation in or lack of participation in these optional programs will have no bearing on future individual team decisions.

I recognize that in case of injury to my son/daughter, the cost of treatment is my responsibility and not the responsibility of the Issaquah School District.

I further acknowledge that before my student can participate in any optional conditioning program this consent form must be signed by me and filed at the school.

I authorize my student:______________________________________________

To participate in supervised open gym/field and or after-school conditioning activities including weight training.

My student has participated in a sports season this year:  yes   no  (circle)

Date:___________________

___________________________                              ______________________________

            Parent Name (print)                                                   Parent Signature

Please turn this form into the activities office (Mrs. Lorbeski), the athletic office (Mr. Porter), or the individual organizing the gym/conditioning program. This form must be submitted prior to participation

BOTH SIDES MUST BE COMPLETED

As a parent or guardian of a student requesting to voluntarily participate in a year around open gym or __________________ summer athletic practice, I hereby acknowledge that I have read, understood and agreed to the following:

I agree to discuss with my child appropriate behavior and conduct that is expected while attending this activity and to get an assurance from my child that they will abide by these expectations including proper respect to the adult coach(s)/staff-in charge and others participating in the program.

I hereby give my permission for_______________________, currently enrolled at_________________

                                                                                                                                                                (School name)

To participate in the open gym or summer practice located at_________________________on/during

                                                                                                                                (school name)

_______________________.

                (Date(s))

Student's Address:_____________________________________ City: ___________________________

Student's Home Phone:_________________________________ Date of Birth:____________________

Parent/Guardian's Name:_______________________________ Cell Phone:______________________

Family Physician:______________________________________ Phone Number:__________________

Medical Insurance Name:_______________________________  Policy Number:__________________

Medical conditions, medication information or allergies:

______________________________________________________________________________________

In the event of an emergency, I wish the following person to be notified in case I cannot be contacted:

__________________________________Relationship:_____________________Phone:_____________