• Ross School Athletic Waiver

                                                        Ross School District
                                                                2019 - 2020

                                 Ross School Athletics Participation and Liability Waiver Form

    Student Name                                                            Male/Female                     Grade

    Home Phone Number                                                Email Address

    Home Address                                                           Date of birth

    Parent/Guardian Name                                              Emergency Contact/Phone #

    Please check the appropriate sport(s) listed below (you may check all sports that apply for the year or pay for one sport at a time for the 2019 - 2020 school year):

    ____        Co Ed Cross Country $50 (shorter season)

    ____        Girls Volleyball $75

    ____        Girls Basketball $75

    ____        Boys Basketball $75

    ____        Co Ed Track $50 (shorter season)

       Participation Donation

        A contribution of amount listed above per sport is requested from each student for continuing support of this after-school sports program.

    _____        Total Number of sports

    ____x $ =

    _____        Total participation donation attached
                            (Make checks payable to Ross School and attach to this form)

    Liability Waiver
    I hereby Release Ross School District, its employees, officers, agents, and volunteers of any liability in the case of injury or illness incurred while participating in the above mentioned sports activities, including transportation to and from sports activities.  In the event that I cannot be reached in an emergency, I hereby give permission for Ross School District’s representative or the assigned coach to authorize by his/her signature whatever emergency medical treatment may be considered necessary by the attending physician for my child.  I have read and understand the above statement and I understand it is a release of all claim for injuries and damages, except in the case of negligence.  My signature evidences acceptance of the provisions of the above statement. 

    Parent/Guardian Signature__________________________________________________

Last Modified on July 31, 2019