Our/my child/guardian, _______________________________, has permission to attend all trips associated with the Girls Cross Country/Track team for the 2008-2009 school year. This includes scrimmages, regular season games, jamborees, tournaments, playoffs and other special functions. I further understand that a coach will be present on all of these trips. I/we give permission to the following coaches to authorize emergency medical care, in our absence, on any and all of these trips:
Coach Shauna Bell Coach Trina McKnight
Coach __________ Coach _____________
Further related to the trips:
1. I authorize an adult, in whose care my child has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnostic or treatment, and hospital care, to be rendered to the child under the general or specific supervision and or the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis is rendered at the office of said physician or at said hospital.
2. As parent/legal guardian, I shall be liable and agree to pay all costs and expenses incurred in connection with such medical/dental services which should be rendered to the aforementioned student pursuant to this authorization.
3. Should it be necessary for my child to return home due to medical reasons or otherwise, I shall assume all transportation cost.
4. I also give my permission for my child to ride in any vehicle designated by the adult in whose care my child has been entrusted while attending and participating in activities sponsored by Spring Valley High School.
5. I understand and agree that my child shall behave in a manner consistent with school policy and will be subject to that policy while participating in the aforementioned activity.
___________________________ ________________________
Athlete Name (printed) Athlete Signature
___________________________ ________________________
Parent/Guardian (printed) Parent/Guardian Signature
___________________________ ________________________
Health Care Provider Policy/Plan Number
(Must be signed in the presence of Notary—required of all Athletes to avoid additional forms during season activities)
RICHLAND COUNTY, SOUTH CAROLINA I, being duly sworn, do depose and affirm that I am the parent or legal guardian of the above named student and, therefore, have the right to delegate the aforementioned rights to the chaperones named during the time period described in the aforementioned school activity.
____________________________ __________________________________
Date Parent/Guardian Signature
Subscribed and sworn before me on the _________day of _________________________, 20____.
My Commission Expires: ___________________