Homeschool Athletic Form

This form must be completed for every homeschool student in K4–5th grade who intends to participate with Geneva youth sports. This form is valid through the end of the school year.

Student's name * Required
First Last
Student's date of birth * Required
MM
DD
YYYY
Grade of student * Required
Sports in which student is planning to participate * Required
Mother's name * Required
First Last
Mother's contact phone number * Required
Father's name * Required
First Last
Father's contact phone number * Required
Name of an emergency contact person (will only be contacted if parents cannot be reached) * Required
First Last
Emergency contact person's phone number * Required
Relationship to student * Required
Student Medical Information
Medical conditions * Required
Please list any medical conditions that coaches and physicians should be aware of before treating your child. If there are none, please write "none".
Name of child's physician * Required
First Last
Phone number of child's physician * Required
MEDICAL AND PARTICIPATION RELEASES
Medical Release * Required
- If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them above. In the event an emergency occurs, I may be reached at the telephone number listed above. If I cannot be reached, I hereby authorize a coach or TGS representative to make emergency medical decisions for my child.
Athletic Participation Consent and Release * Required
- I understand that if my child participates in a Geneva athletic team/squad, I give permission for them to participate with full knowledge that said activity could result in injury.
  
  Participation in competitive athletics may result in severe injury, including paralysis or death. Improvements in equipment, medical treatment, and physical conditioning, as well as rule changes, have reduced these risks, but it is impossible to totally eliminate such occurrences from athletics.
  
  I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby hold The Geneva School, Inc., (TGS), and its agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses and damages on account of injury to my child or property, even injury resulting in death, which I now have, or which may arise in the future in connection with the activity or participation in any other associated activities.
  
  I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, not-withstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital.
  
  I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
Email address to confirm receipt of this form * Required
Enter Email Confirm Email
Name of person submitting form * Required
First Last

Homeschool Athletic Form

Student Medical Information

MEDICAL AND PARTICIPATION RELEASES

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