SMUS - ATHLETICS

Student Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone

(###)

###

####

Parent/Guardian Name *

First Name

Last Name

PARENT/GUARDIAN ACKNOWLEDGEMENT OF RISK & CONSENT: *

The undersigned, as the parent(s) or guardian(s) of the student, having reviewed with the student the material provided by SMUS on the activity, hereby: a) Consent to the student participating in the activity. b) Recognize and understand the inherent risks associated with the activity including but not limited to the hazards of vehicle travel, water travel, snow travel, accident/illness in places without nearby medical facilities, weather and other circumstances beyond the control of St. Michaels University School employees, related parties and agents. c) Authorize the activity leaders to consent to medical treatment for the student by any qualified medical practitioner as may be necessary in the event of an emergency. d) Understand the specific risks associated with the sport of basketball, including but not limited to sprains, strains, bruises etc. Consequences of these risks may result in physical or emotional injury, paralysis, death or damage to property or third parties.

I, as parent/guardian, have read and acknowledge these risks and give consent for my child to participate in basketball