<p> FORT MORGAN SCHOOLS ACTIVITIES / ATHLETICS</p><p>Student Name: ______Birth Date: ______Grade: ______</p><p>PHYSICAL EXAMINATION FOR ATHLETIC PARTICIPATION</p><p>I hereby certify that I have examined this student and that he/she was found physically fit to engage in school sports.</p><p>Exceptions: ______</p><p>Signature of MD/DO, PA, NA, DC-SPC#: ______Date of exam: ______(Good for 365 days)</p><p>AUTHORIZATION FOR TREATMENT OF A MINOR</p><p>As the parent of legal guardian of the above named student, I give my consent for the emergency medical and surgical treatment of this minor in a licensed hospital by a licensed Colorado Physician should his/her condition so require it in my absence. I understand that in such a case, reasonable attempts would first be made to contact me--time and conditions permitting. As long as the medical or surgical treatment considered necessary in the situation is in accordance with generally accepted standards or medical practice for the particular type of injury or illness involved, I impose no specific limitation or prohibitions regarding treatment other than those that follow: ______.</p><p>If you have no insurance, please contact the school Insurance company and policy number office for information on purchasing insurance. must be included</p><p>______Parent / Guardian Name Home Phone # Work Phone # Insurance Company</p><p>______Second Contact Name Second Contact Home # Second Contact Work # Policy Number</p><p>RISK ACKNOWLEDGEMENT</p><p>WARNING: Although participation in supervised interscholastic athletics and activities may be one of the least hazardous in which any student will be involved, in or out of school, by its nature, participation in interscholastic athletics includes risk of injury which may range in severity from minor to long-term catastrophic injury. Although serious injuries are not common in supervised school athletic programs, it is impossible to eliminate this risk.</p><p>Players must obey all safety rules, report all physical problems to their coaches, follow a proper conditioning program, and inspect their own equipment daily.</p><p>By signing this Permission Form, we acknowledge that we have read and understood this warning. Parents or students who do not wish to accept the risks described in this warning should not sign this permission form.</p><p>I understand that my son/daughter will be governed by athletic training rules and regulations as a participant in the Fort Morgan Schools Activities and Athletics. I also understand that we may be responsible for participation fees or fines due to lost equipment or items issued to our son/daughter.</p><p>I maintain adequate insurance coverage for my son/daughter that will pay medical and hospital bills resulting from possible injuries sustained while participating in certain activities.</p><p>PARENT/GUARDIAN PERMISSION - STUDENT CONTRACT ACCEPTANCE</p><p>I hereby give my consent for my child to participate in activities / athletics offered by Fort Morgan Schools. We (parent and student) have read and understand the above information and agree to abide by Fort Morgan Schools rules and regulations.</p><p>Student signature: ______Date</p><p>Parent signature: ______Date</p>