TKE Student Permission to Participate              SY24 4th/5th Girls Basketball

Event Location:  TKE Gym 
Coach: Mrs. Kelsey  
Practice Days:  Monday and Friday 

No practice: 10/20, 10/23, 11/3, or 11/10

Time: 3:00pm-4:30 pm 
Begin Date: 10/2
End Date: 11/11
Fee: $30   Pay here:  https://www.schoolpay.com/link/basketball2022-2023 
 
ACTION NEEDED: Enter your student's practices into School Dismissal Manager www.schooldismissalmanager.com 
 
Description: 
This year Mrs. Kelsey will be coaching Girl’s 4th and 5th-grade basketball. Basketball is a team sport that focuses on many locomotor and non-locomotor movements along with communication/team-building skills.  Fundamentals that will be worked on include dribbling, ballhandling, passing, and shooting (lay-ups and jump shots). Talkeetna Student athletes will better understand conditioning, team building, and competition.  

Equipment needs: All students should bring a water bottle to practice and have appropriate footwear for the gym floor. All students will have appropriate clothing for practice (shorts or sweats, please no Jeans or dresses.) Bring an after school snack.

 Basketball Team Expectations:  

1. Always demonstrate sportsmanship.

2. Be respectful to oneself and all other athletes, your coach, the facility, and all equipment.

3. Maintain a positive attitude and have fun!  - Coach Kelsey

5th Grade Jamboree will be held at Teeland middle school on Saturday November 11th. Games times TBD.

Sign in to Google to save your progress. Learn more
Email *
First Name of Student: *
Last Name of Student: *
Grade
Clear selection
First Name of Student:
Last Name of Student:
Grade
Clear selection
My student(s) has/have permission to participate: *
Payment Information *
Emergency Contact Name *
Emergency Contact Phone *
Medical or physical problems requiring assistance. Please explain.
Special instructions or information regarding myself or my student:
Photo Release:  I give permission for my student to be included in periodic photos that may be posted on the TKE Facebook page, TKE front office digital signage, yearbook, or TKE Newsletter.   *
After reading about the risks of participation, please review the paragraphs below, initial the insurance notification statement, and click I understand to indicate you have read and understood all items outlined herein.   Release of Liability, Waiver of Claims, Assumption of Risks, and Indemnity Agreement  I understand that the extra-curricular activity named above has a certain degree of inherent risk, which includes known and unknown risks. I understand that such risks may result in personal injury, illness, psychological injury, death, or property damage. I understand that any of these may impair the participant’s future ability to earn a living, to engage in business, social, and recreational activities, and to generally enjoy life. I understand the following describes some but not all of the risks:• Inadequate supervision, and failure to give adequate warnings or instructions• Failure by participants to heed warnings or follow instructions• The participant’s own negligence and the negligence of others• Slipping, tripping, or falling• Failure to properly maintain vehicles and vehicular accidents• Violence/unlawful acts perpetrated by any individual• Exposure to or contraction of bacteria, viruses, and diseases, including COVID-19 *
Required
COVID-19 Affirmation and Additional Risk Disclosure•    I AFFIRM that neither I, my child(ren), nor anyone in my immediate household, including the student participant in this activity, have been diagnosed with, demonstrated any symptoms of, or have been exposed to COVID-19, and/or any mutation or variation thereof within the past 14 days.• I understand that participation in this activity during the COVID-19 Pandemic increases the risk of exposure toCOVID-19, and/or any mutation or variation thereof. I am also aware that such exposure can occur directly or indirectly. I understand that the risk of exposure cannot be eliminated. I understand that the risk of exposure includes mandated quarantining, short- or long-term hospitalization, permanent injury, and death, as well as psychological injury. I understand that exposure may impair the participant’s future ability to earn a living, to engage in business, social, and recreational activities, and to generally enjoy life. I further understand that some individuals are more susceptible to the risks of exposure to COVID-19, including people over the age of 65,people with serious underlying health conditions such as high blood pressure, chronic lung disease, diabetes,obesity, asthma, and those whose immune systems are compromised. I understand that if I or my participating children fall within one of these categories, there is greater risk.
Clear selection
I understand that the Matanuska-Susitna Borough School District (District) will NOT assume any liability orresponsibility for injury, illness, death, damages, losses, or costs that may occur or be incurred resulting fromparticipation in this activity.
Clear selection
I agree that participation in the activity is VOLUNTARY and based on my independent assessment of all of the risks set forth above.
Clear selection
By signing below, I acknowledge that the participant and I are ULTIMATELY RESPONSIBLE for my/his/her own safety during participation in District activities, including the use of facilities and equipment. I understand that primary accident and medical insurance coverage is my responsibility, and I have been made aware of my ability to purchase Myers-Stevens & Toohey, Inc. Student Accident Insurance. In the event of an injury or illness related to participation in this activity, I give my consent for emergency treatment, hospitalization, or other medical treatment as may be deemed necessary by emergency medical personnel, hospitals, physicians and other medical providers. IN CONSIDERATION FOR PERMISSION TO PARTICIPATE IN THIS DISTRICT ACTIVITY, I FOR MYSELF, THE PARTICIPANT, AND ANY HEIRS, SUCCESSORS, EXECUTORS, AND SUCCESSORS, KNOWINGLY, INTENTIONALLY, AND VOLUNTARILY WAIVE AND FOREVER RELEASE, INDEMNIFY AND HOLD HARMLESS THE DISTRICT, ITS BOARD MEMBERS, ADMINISTRATORS, TEACHERS, COACHES, AGENTS AND INSURERS, FROM ANY AND ALL CLAIMS OF LIABILITY FOR INJURY, ILLNESS, DEATH, DAMAGES, LOSSES, OR COSTS THAT MAY OCCUR OR BE INCURRED RESULTING FROM PARTICIPATION IN THIS ACTIVITY.
Clear selection
Having read the statements above and having understood the dangers and potential risks involved with participation in the listed activity, I hereby give my consent as an adult or emancipated minor participant or the parent/legal guardian of the participant named above.
Clear selection
I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTAND IT, AND I AGREE TO BE BOUND BY ITS TERMS. By signing, I acknowledge that a court of law may determine that I have waived my right to maintain a lawsuit for any claim which I have released above.
Clear selection
Parent / Guardian or Adult Signature (Type Name) *
Date Signed *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Matanuska-Susitna Borough School District.

Does this form look suspicious? Report