AUSTINTOWN FITCH HIGH SCHOOL DEPARTMENT OF ATHLETICS
 STUDENT PARTICIPATION and INSURANCE FORM

     
Student's Name:
   _____________________________________________
Street Address:
  _____________________________________________
Zip Code:
  _____________________________________________
Home Phone:
  _____________________________________________
     
I understand and realize that there is risk of injury in participating in interscholastic athletics. As legal guardian of the above named student, I grant him / her my permission to participate in:
     
Baseball Basketball Cross Country
Football Golf Gymnastics
Softball Soccer Tennis
Track & Field Volleyball Wrestling
Other: Other:  
     
This permission is granted with the understanding that the school and its representatives will assume no financial or legal responsibilities for any injuries that may occur to him / her as a result of such participation.
     

PLEASE CHECK THE APPROPRIATE INSURANCE INFORMATION BELOW

I currently have adequate insurance coverage and do not wish to purchase the student accident insurance plan offered through the school.

I have purchased the student accident insurance plan offered through the school.

 

Date:  _____________________          Signature:____________________________________________