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August 09

 

INFORMED CONSENT

AWARENESS OF SPORTS INJURY RISK

WARNING AND AGREEMENT

 

By its very nature, competitive athletics can put students in situations in which SERIOUS,

CATASTROPHIC, and perhaps FATAL accidents could occur. Students and parents/guardians must assess the risks involved in such participation and make their choice to participate in spite of those risks. No amount of instruction, precaution or supervision will totally eliminate all risk of injury. Just as driving an automobile involves choice of risk; participation in athletics is inherently dangerous. The obligation of parents and students in making this choice to participate cannot be overstated.

 

By granting permission for your son/daughter to participate in athlete competition, a parent or guardian acknowledges that playing or practicing in any sport can be a dangerous activity involving MANY RISKS OF INJURY. Both the athlete and parent must understand that the dangers and risks of playing, or practicing to play, include but are not limited to, death, complete or partial paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles, tendons and other aspects of the skeletal system and potential impairment to other aspects of the body, general health and well being.

 

Because of the dangers of participating in sports, we (parent/guardian and player) recognize the importance of following coaches instructions regarding playing techniques, training, equipment and other team rules, etc. both in competition and practice and agree to obey such instructions.

 

If any of the preceding is not completely understood and you have questions, please contact 5the school.

 

I have read and understand the information above and give my son/daughter permission to participate in St. Pauls Lutheran School Athletics.

 

 

Athletes Name (Please Print)________________________________________ Grade ____

 

Athletes Signature _______________________________ Date_____________

 

Parent/Guardians Signature_______________________________ Date___________

 

Release and Affirmation: We hereby affirm that we are aware of the inherent risks and hazards of interscholastic athletics and by signing this release certify that we are cognizant of those risks. We understand and agree that neither St. Pauls Lutheran Church/School nor any of its employees and agents may be held liable in any way for any occurrence, including rescue operations, in connection with athletics that may result in injury, death, or risks in connection with related activities related thereto for any harm, injury, or damage which may befall me and further to save and hold harmless the Church, School, and all persons associated therewith from any claims by us, or our families, estates, heirs, or assigns out of enrollment and participation in athletics.   This is to be signed by the student and his/her legal parents/guardian with their consent. We understand that the terms herein are contractual and not mere recital, and that this has been signed freely and voluntarily. It is the intent of the signers hereto to exempt and release St. Pauls Lutheran Church/School and all of its agents and derivative damage caused by anyones act, error, omission or negligence.   We have fully informed ourselves of the contents of this Release and Affirmation by reading and understanding it before we signed it.       MOTHER __________________________________________ FATHER _______________________________________________   LEGAL GUARDIAN ___________________________________STUDENT ___________________________________________

 

Medical Treatment and Student Insurance Statement

 

 

 

 

Student ________________________________________ Birthdate_______________ Grade _________

 

 

 

During school hours and all school events and activities, including all athletic events, first aid shall be administered to an injured student by a representative of the school unless a physician or emergency medical personnel are present; in the latter case, the physician or emergency medical personnel will render first aid. Coaches will have Student Information Cards with them at all practices and games.

 

If any injury occurs to a student at school during school hours or any school sponsored event or activity, and the injury appears to be serious, the injured student will be conveyed to a doctor, hospital, or clinic for treatment (if possible, to the doctor or hospital preferred by the parent/guardian). If the injury occurs off school premises at a school event or activity, and the injury appears to be serious, medical treatment will be provided as is reasonable available. If the injury appears serious, the injured student will be conveyed to a doctor, hospital, or clinic for treatment (if possible, to the doctor or hospital preferred by the parent/guardian).

 

Transportation to a medical facility, if required, will be determined by the coach, athletic director, or parents/guardians.

 

The parent of a student who incurs an injury which requires more than first aid will be notified as soon as practicable after the injury occurs. In an emergency situation, this notification may not occur until after the student has been conveyed to the appropriate doctor, hospital, or clinic for treatment.

 

We understand that St. Pauls does not carry any medical expenses insurance for the benefit of any student who may be injured at school or while participating in a school sponsored event or activity, including athletic events, and that St. Pauls nor its coaches assumes any responsibility for such expense.

 

We have read and understand the procedure described above for the treatment of a student who may be injured at any school event or activity. We consent to having our son/daughter participate in all school activities and events, including athletic events, involving St. Pauls under these conditions and authorize medication treatment of injuries incurred by our child according to the procedure described above.

 

 

 

__________________________________ ___________________________

Parent/Guardian Signature Date

 

 

 

 

Parental Consent for Student Participation

St. Pauls Lutheran School Interscholastic Athletics

 

 

 

Below is an acknowledgment that the student and parent(s) have read and understand St. Pauls Athletic Handbook and are willing to abide by and support the aforementioned guidelines. Any situation that occurs during a season that is not covered in the Handbook will be acted upon at the discretion of the coach, Athletic Director, and Principal.

 

By signing below, you are stating that you:

 

1. Have read and understand the athletic guidelines and will support and abide by them.
2. Understand that athletic programs are extracurricular activities and in order to participate, your child must be working up to his/her potential in the classroom and meet basic academic and behavioral requirements of his/her teachers.
3. Are aware that your child may be suspended from those activities until the requirements are met
4. Agree to cooperate and support the coaches at St. Pauls.
5. Wish your child to participate in St. Pauls Interscholastic Athletics.

 

 

 

 

 

STUDENT:___________________________________________

 

FATHER ___________________________________________

 

MOTHER __________________________________________

 

LEGAL GUARDIAN __________________________________

 

 

DATE : _____________/_______/ 200__

 

Preamble:
Interscholastic and youth sports programs play an important role in promoting the physical, social and emotional development of children. It is therefore essential for parents, coaches and officials to encourage youth athletes to embrace the values of good sportsmanship. Moreover, adults involved in youth sports events should be models of good sportsmanship and should lead by example by demonstrating fairness, respect and self-control.

I therefore pledge to be responsible for my words and actions while attending, coaching, officiating or participating in a youth sports event and shall conform my behavior to the following code of conduct:

1. I will not engage in unsportsmanlike conduct with any coach, parent, player, participant, official or any other attendee.
2. I will not encourage my child, or any other person, to engage in unsportsmanlike conduct with any coach, parent, player, participant, official or any other attendee.
3. I will not engage in any behavior which would endanger the health, safety or well-being of any coach, parent, player, participant, official or any other attendee.
4. I will not encourage my child, or any other person, to engage in any behavior which would endanger the health, safety or well being of any coach, parent, player, participant, official or any other attendee.
5. I will not use drugs or alcohol while at a youth sports event and will not attend, coach, officiate or participate in a youth sports event while under the influence of drugs or alcohol.
6. I will not permit my child, or encourage any other person, to use drugs or alcohol at a youth sports event and will not permit my child, or encourage any other person, to attend, coach, officiate or participate in a youth sports event while under the influence of drugs or alcohol.
7. I will not engage in the use of profanity.
8. I will not encourage my child, or any other person, to engage in the use of profanity.
9. I will treat any coach, parent, player, participant, official or any other attendee with respect regardless of race, creed, color, national origin, sex, sexual orientation or ability.
10. I will encourage my child to treat any coach, parent, player, participant, official or any other attendee with respect regardless of race, creed, color, national origin, sex, sexual orientation or ability.
11. I will not engage in verbal or physical threats or abuse aimed at any coach, parent, player, participant, official or any other attendee.
12. I will not encourage my child, or any other person, to engage in verbal or physical threats or abuse aimed at any coach, parent, player, participant, official or any other attendee.
13. I will not initiate a fight or scuffle with any coach, parent, player, participant, official or any other attendee.
14. I will not encourage my child, or any other person, to initiate a fight or scuffle with any coach, parent, player, participant, official or any other attendee.
15. I WILL do my best to be a positive example of Christian Sportsmanship to others.

I hereby agree that if I repeatedly fail to conform my conduct to the foregoing while attending, coaching, officiating or participating in a youth sports event I will be subject to disciplinary action, including but not limited to the following in any order or combination:

1. Verbal warning issued by a league, organization or school official.
2. Written warning issued by a league, organization or school official.
3. Suspension or immediate ejection from a youth sports event.
4. Suspension from multiple youth sports events.
5. Season suspension.

________________________	________________________	___________
Name	Signature	Date

 

ST. PAULS LUTHERAN SCHOOL

ATHLETIC TRANSPORTATION POLICY

 

St. Pauls Transportation Policy states All parents who transport their children and/or children of other parents to and from athletic events/practices must have a liability waiver on file with the schools athletic director.

 

For parents /guardians who provide transportation to these events, they must be aware of the following:

• Where parents/guardians provide transportation to their son/daughter to or from an event, the parents/guardians shall assume all resulting liability, and the church/school shall assume no liability.
• Where parents /guardians transport students other than their own to or from an event, the parents/guardians shall assume all resulting liability, and the church/school shall assume no liability.

 

ST. PAULS LUTHERAN SCHOOL TRANSPORTATION LIABILITY WAIVER   I have read the Athletic Transportation Policy and agree that I shall assume all liability for negligently caused injuries resulting from the following situations:   Where I transport my son/daughter to or from an event; Where I transport other students to or from an event;   I also agree that St. Pauls shall assume no liability whatsoever for negligently caused injuries resulting from the above situations or any other situation where contracted transportation is not being used to transport athletes.   _____________________ ___________________ Parent/Guardian Signature Date