Nordonia Middle School Athletic Department

THIS PAGE MUST BE COMPLETELY FILLED OUT AND RETURNED WITH A CURRENT PHYSICAL AND EMERGENCY MEDICAL AUTHORIZATION

As a member of a Nordonia Middle School Athletic Team, you will be issued a uniform and/or equipment. You are responsible for the upkeep of this uniform. The uniform and equipment will be turned in at the end of the season. You are responsible for the loss or damage of any part of this uniform. At the end of the season, the coach and athletic director will determine if any costs due to loss, damage, or abnormal wear and tear are to be assessed.

Student Name (PRINT)_________________________________________________

Parent or Guardian Signature________________________________________________

ACKNOWLEDGMENT OF WARNING BY PARENTS/STUDENTS

We/I the parent(s) of___________________

Do hereby acknowledge that we/I have been fully advised, cautioned and warned by the administration and coaching staff of Nordonia Hills City Schools that our/my child named above may suffer injury including but not limited to sprains, fractures, brain damage, paralysis or even death, by participation in the sport of:

_____7^th Grade_____________________(sport)

_____8^th Grade_____________________(sport)

Notwithstanding such warnings and with full knowledge and understanding of the risk of serious injury or our/my child named above which may result, we/I gave our/my consent to participate in athletics.

Athlete_________________________________

Parent/Guardian_________________________

ATHLETIC DEPARTMENT INSURANCE WAIVER

We the undersigned, parent(s)/guardian(s) of

___________________do hereby release the Nordonia Athletic Department from any and all financial responsibilities as a result of any and all injuries incurred by our son/daughter as a direct result of his/her participation in pre-season conditioning programs and interscholastic athletics.

We certify that such injuries which might by sustained by our son/daughter as a result of participation in preseason conditioning programs and interscholastic athletics are covered by our family insurance.

For those parents/guardians who want excess coverage, the Nordonia Board of Education encourages you to enroll your student in an insurance program.

Parent/Guardian_______________________

Date_______________________