2021-2022 HS Fitness Center Permission Form
This permission form must be completed by a parent/guardian before student use of the Fitness Center after school.  This permission form certifies that the student listed below has parent/guardian permission to use the Oley Valley High School Fitness Center.   Use of the Fitness Center after school is limited to students in grades 9-12 and all students must leave/be picked up by 4:30PM.  Students must follow all health and safety rules and protocols in the Fitness Center and are expected to put all equipment back in the proper locations.  Failure to follow health and safety protocols and/or not returning equipment to the proper locations will result in the student's privilege to use the Fitness Center to be revoked.  
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Email *
Student Last Name *
Student First Name *
Student Grade *
To the Parent/Guardian: To serve your child in case of accident or sudden illness, it is necessary that you furnish the following information for emergency calls.
Parent/Guardian #1 Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #2 Name
Parent/Guardian #2 Phone Number
List a relative/neighbor who will assume temporary care of your child if you cannot be reached (Emergency Contact): *
Emergency Contact Phone Number *
List any health conditions such as heart disease, diabetes, epilepsy, severe allergies, eye or ear problems, any chronic condition, etc.  Also please list any medications that your child is presently taking.  (Please put N/A if no health conditions are of concern and no medications are taken) *
Student's Physician's Name *
Student's Physician's Phone Number *
Hospital Choice *
In the event the above named contacts cannot be reached, I the undersigned do hereby authorize the representatives of the Oley Valley School District to take whatever action is deemed necessary in the judgement for the health, welfare, and safety of aforesaid child.  I will not hold the school district financially responsible for the emergency care and/or transportation for said child.  My electronic signature below releases the Oley Valley School District from all liability of my child using the High School Fitness Center after regular school hours and attests that my child is in good health and physically capable of participating in cardiovascular and strength exercises.  All students utilizing the Fitness Center after school are required to abide by all Oley Valley School District policies, including being academically eligible and not included on any OVSD debt list.  This form must be signed by a parent or legal guardian.  Your name typed below is your legal signature that confirms all information provided above is true, and your acceptance of the conditions and rules of use for the High School Fitness Center for your child.
Electronic Parent/Guardian Signature *
A copy of your responses will be emailed to the address you provided.
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