Please complete the information requested below allowing your student permission to participate in school sponsored athletic events, and to be transported by public transportation, the student’s personal vehicle, and/or staff members, parents, or others driving personal vehicles. Student athlete drivers may only transport members of their immediate family.

STATEMENT OF CONSENT

WAIVER, RELEASE & INDEMNITY

In consideration for the participation of my son/daughter in a school-sponsored athletic event, I agree to release the Holy Name Catholic School, its agents, employees, and representatives (in their individual and official capacities) from any and all claims that we/I as parent(s)/guardian(s) or my/our child may have for any losses, damages, or injuries arising out of my/our child’s participation in or transportation to/from an athletic event, or in connection with the rendering of emergency medical procedures or treatment, if any.  This release applies regardless of whether the damages and/or injuries are caused by the negligence of the District’s Board of Education, individual members, agents, employees, or representatives.  I/we understand that participation in a school-sponsored athletic event is voluntary and may involve a risk of injury to persons and/or property and assume any such risk that may arise therefrom.  I/we accept full financial responsibility for all medical expenses for any injuries that may occur to our/my child during his/her participation in the athletic event or transportation related thereto.  Finally, I/we agree to indemnify the school, its agents, employees, and representatives for all claims, liabilities, actions, causes of actions, and actual attorney’s fees and litigation costs arising from or relating to our/my child’s participation in, or transportation to/from the school sponsored athletic event.

All transportation to/from athletic events will be using privately insured personal vehicles or public transportation. No utilized transportation is insured by the school. Please Note: The minimal, acceptable liability limit for privately owned vehicles is $500,000 CSL (Combined Single Limit). Due to some insurer’s limitations, limits of $250,000 per person/$500,000 per occurrence are acceptable.

I confirm that by signing this Form that, as my/our child’s parent/legal guardian, I/we understand and acknowledge my/our agreement to all these terms.

Acknowledgement/Signature