Your child will have the opportunity to participate in the SCRS Intramural Sport and Scholastic program this year.  We have seven events scheduled throughout the school year.  Your child will be provided with a team T-shirt to wear on the Sports/Scholastic days scheduled.  We need your permission for your child to participate as well as your child's shirt size.  Please sign the form below.

I, the undersigned parent(s) or guardian(s), hereby consent to my child, __________________________, to participate in the activities connected with the SRCS Intramural Program.

I certify that my child is able to participate in these activities.  If my child has medical conditions which may be relevant to a physician in the even of an emergency, I have listed them below.  In the even that an emergency occurs, I may be reached at the telephone number listed below. If I cannot be reached within a reasonable period of time, as determined by school officials, I hereby authorize the school or the adult sponsor, Mr. Tod Brainard, to make emergency medical decisions for my child.  If there are any activities that I do not want my child to be involved in, I have listed them below:

-Medical conditions to be aware of:  ___________________________________________________________
 

-Insurance company and policy number: ________________________________________________________
 

-Physical restrictions: ______________________________________________________________________
 

-Instructions and medications: ________________________________________________________________
 

-Date of last tetanus or booster:  ______________________________________________________________
 

-I do not wish my child to participate in the following: _______________________________________________
 

-Telephone numbers where I may be reached in an emergency: _______________________________________

_______________________________________________________________________________________

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO.   I do, for myself and for my child, heirs and assigns, hereby irrevocably and unconditionally release, acquit and forever discharge Santa Rosa Christian School and its agents, employees, and volunteers from any and all liability, actions, causes of actions, claims, expenses, obligations and damages of any nature whatsoever, which I now have or which may arise in the future, in connection with my child's participation in the described activity or in any other associated activities, including, but not limited to, any injury to my child or property, even injury resulting in death.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Florida, and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.  This release contains the entire agreement between the parties hereto.

I further state that I HAVE CAREFULLY READ AND UNDERSTAND THE FOREGOING RELEASE AND KNOW THE CONTENTS HEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT.  I understand that this is a legally binding agreement.

                                                                                                 _____________________________________    _________________

                                                                                                   Parent or Guardian                                                        Date

Circle Appropriate T-shirt size:

                     YS          YM          YL          AS          AM          AL          AXL          AXXL