SAMPLE
719
361/555-1234
OFF-CAMPUS PHYSICAL
EDUCATION PERMISSION
TO BE COMPLETED BY PARENT AND STUDENT:
I have carefully read the guidelines of the
Off-Campus Physical Education program and I agree to comply with those
regulations. I hereby release the XYZ
Charter School, its employees, agents, and Board of Directors, from all claims
or liability in any way attributable to this program, including all travel to,
from, and during the program. I also
understand that all liability in case of accident or hospitalization is the
responsibility of the parent or of the private or commercial school. The XYZ Charter School is not responsible for
accident or hospitalization insurance. I
understand that the XYZ Charter School has no control over the daily activities
of the program, quality of the program, or qualification of the instructor in the program.
My
son/daughter _________________________________________ has permission to
participate in
the
Off-Campus Physical Education Program for
_________________ at ______________________.
(Off-Campus Sport)
(Off-Campus Agency)
Parent/Guardian
Signature: _________________________________ Date: _________________
Student
Signature: ________________________________________ Date: _________________
If you have questions regarding this application, please
call the office at (xxx) xxx-xxxx.
III. 41