International School of Port of Spain
ATHLETIC DEPARTMENT
Acknowledgement of Risk of Injury/Waiver
I, the undersigned parent or guardian of
________________, a minor, or __________, a student having reached the age
of majority, hereby acknowledges that I have been properly advised,
cautioned, and warned by the proper administrative and coaching personnel at
the International School of Port of Spain that by participating in organized
high school athletics, _______________,a student is exposing her/himself in
the risk of serious injury, including but not limited to the risk of
sprains, fractures, and ligament and/or cartilage damage which could result
in a temporary or permanent, partial, or complete impairment in the use of
limbs; brain damage, paralysis, or even death.
Having been so cautioned and warned, it is
still _______________’s desire to participate in the sport listed below. It
is hereby further acknowledged that _______________ does so with full
knowledge and understanding of the risk of serious injury to which
______________ is exposing him/her by participating in the aforementioned
sport. The International School of Port of Spain, and their agents,
employees, or members shall bear no responsibility for any accident or
injury (including death) sustained by, _________________, a student while
participating in the aforementioned activities. To this end, I, the
undersigned parent or guardian of _________________, a minor student, or
_____________, a student having reached the age of majority, do hereby
consent to _____________’s/my participation in voluntary athletic programs
and do forever RELEASE, discharge and covenant to protect, indemnify
and hold harmless the International School of Port of Spain, and their
successors, departments, officers, employees, volunteers, servants and
agents, of and from any and all actions, causes of actions, claims, demands,
damages, costs, loss of services, expenses and compensation of whatsoever
kind or nature arising from, or by reason of, on account of or in any way
growing out of directly or indirectly, all known and unknown personal
injuries, including death, or property damages which I may now or hereafter
have as the parent or guardian of said minor student, or as the student, and
also all claims or right of action for damages which I, said student, or any
heirs, executors, administrators, or assigns, any other person acting on the
student’s or his/her estate’s behalf, or any other person has or hereafter
may acquire, either before or after he/she has reached his/her majority
resulting or to result from his/her participation in the International
School of Port of Spain athletic programs.
FURTHERMORE, I/We
hereby agree to protect and save harmless
the International School of Port of Spain Board of Education, and their
successors, departments, officers, employees, volunteers, servants and
agents against any claims for damages, compensation or otherwise on the part
of said student growing out of or resulting from injury, including death, to
said student in connection with his/her participation in the International
School of Port of Spain voluntary athletic programs, and to INDEMNIFY,
reimburse or make good to the International School of Port of Spain Board of
Education, or their successors, departments, officers, employees,
volunteers, servants and agents any loss or damages or costs, including
attorney’s fees that the Board, or their successors, departments, officers,
employees, volunteers, servants or agents may have to pay if any claim or
litigation arises from said student’s intentional, negligent, grossly
negligent or reckless acts or omissions while participating in said
programs.
Sport ____________________________
Signature of Parent(s)/Guardian(s)
______________________________
Date ______________ Relationship
____________________________
Signature of Student
_________________________________________
Please complete:
___ Male
___ Female
__________________________________________________________
Student Last Name First Name
__________________________________________________________
Home Address
__________________________________________________________
Telephone Number
Date of Birth