Before a student may be allowed to participate in the athletic program, that student must have a physical form on file, signed by a physician stating that the student is physically fit for participation in sports.  Insurance must also be provided by purchasing it from the school or by signing a statement assuring the school that the student isproperly covered by the parent's or guardian's private insurance policy.  Please complete this form and return it to the coach or the school athletic director.

Student's Name ___________________________Parent's Name _____________________

Address ______________________________ City ___________________Zip __________

Home Phone (    )_____________ Work Phone (    )______________Emerg. (   )________

Insurance Statement

I/We request that our child _____________________________ be permitted to take part in athletics.  I/We assume all risk for accident or injury to our child and release the Fayette County Board of Education and their employees from any liability to our child while participating in athletic functions.

My child is covered by insurance through: _______________________________________

Policy #____________________________________

Yes ______ I want the basic school coverage (forms available through the Front Office).

No _____ I do not want school coverage; I have a personal, private insurance policy.

Signature of Parent or Guardian _________________________________ Date _________

Emergency Treatment

I understand that if my child is injured or becomes ill, every effort will be made by a school official to contact a parent or guardian.  If this is not possible, I grant permission for emergency medical personnel to be contacted and such treatment as is deemed necessary to be administered.

Signature of Parent or Guardian _________________________________ Date _________

Warning Form

I/We give our permission for __________________________________ to participate in organized high school athletics.  Realizing that such activity involves the potential for injury which is inherent in all sports, I/we acknowledge that even with the best  coaching, use of the most advanced equipment and strict observance of rules, injuries are still a possibility.  On rare occasions these injuries can be so severe as to result in total disability, paralysis or even death.  I/We acknowledge that I/we have read and understand this warning.

Signature of Parent or Guardian _________________________________ Date _________