WINNISQUAM REGIONAL SCHOOLS

ATHLETIC DEPARTMENT

ACKNOWLEDGMENT OF WARNING AND CONSENT AGREEMENT

**THIS FORM IS FILLED OUT FOR EVERY ATHLETE EACH SEASON**

Instructions: Please read the ENTIRE form. IF there is anything about this form or the described activity that you do not understand, do not sign the form until you are satisfied that you have obtained a compete explanation. PLEASE FILL IN ALL THE BLANKS. If you have more than one child participating, complete one form per child.

I/WE, _________________________________________ am/are the parent (s)

of _________________________________ DOB ___/____/ _____ A minor, who desires

to participate in the following sport: ________________________            Grade: ________  

                                                                          (1 Sport only)

I/WE acknowledge that I /WE have been informed as to the nature of the sport, and that this sport has risks of injury associated for those who participate, including transportation from and to the school campus. Although the school staff will endeavor to provide each participant with due care, the school cannot ensure that my/our child will remain free of injury.

I/WE represent that our child is physically fit to participate in this sport and, if required, that he/she has been examined by a licensed physician who verifies that my/our child is physically fit to participate in this particular sport. (The School District provides physicals as required by the NHIAA. However, if an athlete has suffered an injury, or been under the care of a physician for an illness, verification by a licensed physician may be required.)

I/WE understand that the school has an obligation to take reasonable precautions for safety and well-being. Our child also has a responsibility for his/her safety and the safety of others.

I/WE acknowledge that I/WE must provide the athletic staff with any medical or other information which I/WE feel is important for the school to know regarding our son/daughter. This information must be kept confidential. I /WE will provide medical and any other information on our child prior to the start of practice for this sport. The school district will rely on me/us to provide this additional information.

I /WE acknowledge my/our child must adhere to all the rules, regulations and instructions pertaining to the safety and protection of the participants, and that failure to comply could exclude my/our child from participation in this sport.

I/We acknowledge and understand the risks and requirements for our child to participate in the sport of ________________________________. I/WE consent to my /our child’s participation in this sport.

Parent / Guardian: __________________________________________

Address: __________________________________________________

               __________________________________Zip _____________

Home Phone: __________________                        Business Phone: __________________

In order to participate in the first day of tryouts you will need to have the following:

1.)    Consent Form  (required every season)          

2) Physical form completed (New physical every year is required)

3.) Proof of insurance (photo copy of card is fine)

Types of Injuries Associated with Each Sport

Basketball:  Sprains, strains, contusions, abrasions, concussions, blisters, cramping, more serious injuries

Baseball / Softball: Sprains, strains, contusions, fractures, eye damage, punctures, dislocations, and more serious injuries

Cross Country: Sprains, strains, abrasions, blisters, cramping and more serious injuries.

  Football / Wrestling: Sprains, strains, contusions, concussions, abrasions, knee and ankle, back and neck problems and more serious injuries.

  Golf: Sprains, strains, upper and lower back problems and more serious injuries.

  Soccer / Field Hockey: Sprains, strains, concussions, fractures, eye damage, punctures, and more serious injuries.

  Spirit: Sprains, strains, concussions, fractures, dislocations, knee and ankle problems, and more serious injuries.

  Track & Field: Sprains, strains, abrasions, blisters, and cramping along w/ more serious injuries.

  Volleyball: Sprains, strains, contusions, abrasions, fractures and more serious injuries.