VISTA MURRIETA HIGH SCHOOL
THIS WAIVER IS ONLY Name: ___________________________
GOOD FOR ONE WEEK Sport: ____________________________
OF SUMMER SPORTS CAMP!!! Date: _____________________________
[pic]
VISTA MURRIETA HIGH SCHOOL
Athletic Department
Summer Camps
Temporary Waiver and Assumption of Risk of Potential Injury
CIF regulations require all student athletes to have an annual physical exam administered by medical practitioner. This is to advise that your child must have this physical completed immediately in order to continue participation in summer camp.
In the interim, your child may participate in the VMHS summer camps for no more than one week provided you attest and agree to the following:
1. My child has been seen by a medical practitioner within the past year and I am aware of no medical conditions that should limit her/her participation in physically demanding athletic activities.
2. I understand that there are risks inherent to participation in athletic activities, which may include severe injury or death, and I acknowledge and assume this risk in allowing my child to participate in same.
3. I will provide documentation of a current physical exam showing medical clearance for my child to participate in athletic activities within one week.
By my signature below, I state that I understand, agree with and attest to the above listed items. In addition, in the event of illness or injury, I do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.
As stated in California Education Code Section 35330, I agree to hold Murrieta Valley Unified School District, its officers, agents and employees harmless from any and all liability or claims which may arise out of or in connection with my child’s participation in this activity.
Student Name: ___________________________________________________Grade:________________________
Parent/Guardian Name: _________________________________________Phone: __________________________
Address: _____________________________________________________________________________________
_________________________________________________________ Student’s Birth Date: __________________
Medical Insurance Carrier: __________________________________Ins. Subscriber’s ID#: _______________
Emergency Contact: __________________________________________Phone: __________________________
Parent/Guardian Signature: ____________________________________________________________________
Rev 4/12/07
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- city of haverhill summer day program
- summer programs residential stjohns
- summer programs henry county schools
- probaseballhs
- registration form for normal west high school 2006 summer
- summer and other special programs for dhhs students
- summer camps programs university of pittsburgh
- vista murrieta high school
- creating camp school partnerships summer camp and youth
Related searches
- high school freshman school supply list
- high school federal school codes
- high school back to school list
- online school for high school credit
- high school school supply list
- high paying jobs without high school diploma
- high school summer school classes
- high school school supplies list
- high school to flight school army
- high school summer school schedule
- high school summer school online
- public high school vs private high school