• Student Information

  • (check all that apply)
  • Parent / Guardian Information

  • Emergency Contact (if parent is unreachable)

  • Parent / Legal Guardian Consent

  • I hereby give my consent for the above named student to compete in sports, including regularly scheduled trips to other schools on supervised school transportation and I certify that the insurance information provided is accurate.

    Risk Warning: I realize that participating in competitive athletics may result in severe injury, including paralysis or death. It is understood Grace Academy student body and or any Grace Academy employee shares NO responsibility in the payment of medical fees incurred by injuries to participants in its athletic programs.

    Trainer Consent: I give my permission to the athletic trainer or other personnel to administer first aid, follow-up treatment and rehabilitation when appropriate in his/her professional judgment as approved by the consulting physician.

    Emergency Treatment: In the event of an accident or emergency, I give my permission for the school authorities to transport my child to any available doctor or hospital or request their services. In case of a medical emergency concerning the above named student, we, the parents/legal guardians, hereby authorize and consent to our child receiving x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care deemed necessary under general or special supervision and upon the advice of a physician and surgeon licensed under the Medical Practices Act. It is understood that every effort shall be made to contact the undersigned prior to rendering treatment.

    I understand that typing my full legal name in the box below constitutes a legal signature confirming that I acknowledge and agree to the above consent form.