Fillable Printable Athletic Waiver Form - Ohio

Athletic Waiver Form - Ohio

ATHLETIC PARTICIPATION & INSURANCE WAIVER FORM

(Please Print)

Student’s Name ________________________ Parent’s Name ________________________

Address _____________________________________________________________________

_____________________________________________________________________

Phone __________________________

School of Attendance: Firelands High South Amherst Middle (Please circle one)

Current School Year : July 1, _____ to June 30, _____

I understand that participation in any extracurricular activity or sport is a privilege and not an

exclusive right in the Firelands Local School District.

I also acknowledge that there are inherent risks associated and accompanied with sports and

activities and that my child may be injured as a result of an accident arising out of participation in

athletics or activities.

In consideration for permitting my child named above to participate in sports and/or activities, I

release and hold harmless Firelands Local School District and/or its employees, teachers, coaches,

administrators, et al., from any and all liability including, but not limited to liability for injuries or

damages sustained by the individual.

Insurance Waiver

I also understand that my child must be covered by medical and/or accident insurance in order to

participate in sports and hereby certify that my child is covered for injuries and/or death occurring as

a result of participation in, or the practice for, all athletic events as a student in the Firelands Local

School District during the current school year. I also certify that said insurance will be kept in force

during the full time that my child engages in the practice for or participation in athletic events during

the current school year.

Name of Insurance Company ______________________________________________________

Address of Insurance Company ____________________________________________________

I have completed all of the information requested above and hereby certify that I have read and

agree to all of the statements listed above.

___________________________________ ____________________

(Signature of Parent or Guardian) (Date)