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Dear Parent/Guardian:

 

 

 

Your child wishes to participate on a sports team representing Belmar School.  Although every precaution against possible injury is exercised by the coaches, parents are required by law to assume responsibility for consenting to participation, and to risk the liability of injury.  The Belmar Board of Education provides insurance for  medical expenses not covered by your personal or group insurance.  The Board’s accident insurance policy is an Excess policy that is designed to work in conjunction with your individual health insurance. 

 

 

 

Please complete Part I and Part II of the Permission Form below and the attached Health History Questionnaire- Part A and return them to the school nurse as soon as possible.

 

 

 

                                                                                                                              Yours truly,

 

 

 

 

                                                                                                                               David Hallman

 

 

                                                                                                                               Superintendent/Principal

 

 

 

 

PART I

 

 

 

__________________________has my permission to try out for the following sports throughout the school year.                     Child’s Name                                      (Please circle all that apply.)

 

 

                                                                                                                                                                                                               

 

 

SOCCER  CHEERLEADING  BASKETBALL  BASEBALL  SOFTBALL  WRESTLING  CROSS COUNTRY

 

 

 

I understand that the Belmar Board of Education provides insurance coverage but that the insurance may not cover all expenses if my child is injured and that I assume that liability .

 

 

Signature of Parent/Guardian______________________________________________ Date________________

 

 

 

 

PART II

 

 

 

As required by N.J.A.C. 6A:16-2.2 physical examinations for candidates for a school athletic team are to be conducted by the student’s own physician within 365 days prior to the first practice session.    Please sign in the appropriate space below.

 

 

 

 I do not have a physician for my child.  I understand my child requires a physical examination in  order to participate in sports..  I permit Dr. Adler, the school physician, to perform the examination.

 

 

Signature of Parent /Guardian ______________________________________________Date________________

 

 

 

My child’s physician will perform the required physical examination.

 

 

Signature of Parent/Guardian ______________________________________________ Date ________________

 

 

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