PUR SUS SAINT JOSEPH HILL ACADEMY ELEMENTARY SCHOOL, ATHLETIC DEPARTMENT PARENTAL CONSENT/RELEASE OF LIABILITY FORM. (Please Print) Athletic Activities/Sport(s) (if Student Participates in Multiple Name All) Student's Name Birth Date Age Grade Parent/Legal Guardian (1) Address Phone #s: (1) @)_ Parent/Legal Guardian (2) Address eB Phone #s: (I) = =250)} ‘The undersigned parent/legal guardian of the student named above: 1) Acknowledges thatthe student must have a complete, updated medical form on file with the St. Joseph Hill Academy Health Office before the student may participate in practices or games: 2) Certifies said student has no physical injuries, medical or mental problems which would render inadvisable he/she participation in the above activities/sports; 3) Acknowledges that the student may suffer serious injuries or accidents by participating in the above activities/sports; 4) Agrees on behalf of the undersigned and said student to indemnify and hold harmless St. Joseph Hill Academy. its members, directors, officers, employees, agents and affiliates (including coaches and trainers) from any and all claim, loss, damage, cost or expense arising out of the student's 5) Releases, waives and gives up, on behalf of the undersigned and said student, any and all causes of action and claims of the undersigned against St. Joseph Hill Academy, its members, directors, officers, employees, agents and affiliates (including coaches and trainers) arising out of the student's participation. ParenvLegal Guardian Signature Date ‘To Be Completed by St. Joseph Hill Academy Health Office: Medical Forms Received on ___ School Nurse Signature