Parent Release of Liability, Emergency Treatment, Medical Conditions & Insurance Information (2023-24)

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Child's Last Name *

Child's First Name *

Release of Liability Statement *

This is to certify that my son/daughter has my permission to participate in the activities and events of the Kimberly High School Ski and Snowboard Club. I agree to indemnify, save, and hold harmless the Kimberly Area School District and its employees and officers from all liability for any adverse results which may occur.

I Agree

I Disagree

Required

Emergency Treatment *

In the event of an emergency, I give Kimberly Area School Ski and Snowboard Club Advisors permission to treat my child or contact emergency personnel.

I Agree

I Disagree

Required

Medical Conditions *

Are there medical conditions that the advisors should be aware of?

NO, not at this time; however advisors will be made aware of any that arise.

YES, as described below in the "Other" section:

Other:

Required

Insurance Information *

Name of Insurance Provider and Policy Number.

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