Athletics Permission Slip

OLPH Athletics Permission Slip

I give permission to my child/children to participate in “home” and “away” games or “tournaments” with car transportation. *

Please check each box *I agree to direct my child/children to cooperate and conform with the direction and instructions of the supervisory personnel in charge of the OLPH Sports Program. Should it be necessary for my child/children to have medical treatment while participating in OLPH Sports Program, I hereby give the school personnel permission to use their judgment in obtaining medical service for the child/children and I give permission to the physician selected by the school personnel to render medical treatment deemed necessary and appropriate by the physician.I understand that any insurance benefits that are effective have limited application.I waive all claims against the school and chaperons for injury, accident, illness or death occurring during or by reason of the OLPH Sports Program.

I have read and understand the above statements and agree to assume the responsibility it states and waive all claims as indicated. *

Please check each box *I have read and agree to abide by the rules and regulations of the Our Lady of Perpetual Help Catholic School Athletic Program, as stated in the “OLPH Athletic Handbook”.I authorize OLPH Catholic School to bill my Blackbaud Tuition Management account the eighty ($80) dollar sports fee per child, per sport/season and agree to pay the said amount.In the event that my child’s sports jersey is lost, or damaged, I agree to pay a one hundred ($100) dollar uniform fee, per uniform OR a twenty five ($25) dollar late fee if the jersey is not returned by the announced deadline. I authorize OLPH Catholic School to bill my Blackbaud Tuition Management account for any additional fees incurred.

Doctor's Name *

Doctor's Phone *

Medical Condition

Auto Insurance Provider *

Auto Insurance Policy # / Exp. Date *

Parent Phone Number *

Parent Email Address *

Street Address *

Apartment, suite, etc

City

ZIP / Postal Code

Driver's License Number/Exp Date *

Signature *