Winter Sports Consent Form 2021

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Please Fill out this form for your student(s) to participate this fall season

Email *

Name(s) of Student *

I have received a copy of Andover Central School's Interscholastic Athletics Policy. I have read it, and understand the content. I agree to abide by the terms within the Athletics Policy as outlined. *

I agree

Required

Insurance Coverage *

I DO carry some type of Insurance Coverage

I DO NOT carry some type of Insurance Coverage

Required

Permission for Emergency Medical Treatment: In the event of an emergency requiring medical attention, every effort will be made to contact the parent/guardian in order to receive authorization before any treatment or hospitalization is undertaken. I Hereby grant permission for a physician or hospital personnel designated by the Andover Central School District designee to attend to my son/daughter. *

I grant permission

I do not grant permission

Required

Please enter the following below: Home Phone Number, Business Phone Number and Emergency Phone Number *

Parent/Guardian Signature: Please type your name below as agreement to the above statements *

Student Signature(s): Please type student name(s) below as agreement to the above statements. *

A copy of your responses will be emailed to the address you provided.

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