Schools of District Eighty

Sports Physical

______________________________ has been examined and is physically healthy and able to participate in extra-curricular sports activities.

_____ YES

_____ NO

If NO, kindly explain:

Please list any exceptions:

_________________________ ________

Signature of Doctor Date

Schools of District Eighty

Parent’s Permission

for

Athletics & Transportation

Understanding the aims and accomplishments of the interscholastic program, I hereby give my child, ____________________ permission to participate in athletic events. Every precaution will be taken to insure your child’s safety; however, we ask that every student athlete carry school insurance or have the equivalent.

Also, participating in the Leyden-Norwood Athletic Conference requires taking bus trips to other schools in the area and parental permission is requested for this purpose. Every precaution will be taken for the child’s safety, but the teacher, driver, nor school can assume no responsibility in case of accident.

Please check one of the following:

_____ We have school insurance.

_____ We have our own insurance.

_____ We have no insurance.

Please check one of the following:

_____ Yes, my child may participate in athletics and bus participation.

_____ No, I do not give my permission for athletics or transportation.

__________________________ ___________

Signature of Parent or Guardian Date

Emergency Contact Numbers: ___________________________