I acknowledge that my school is a member of the North Carolina Independent Schools Athletic Association (NCISAA) and must adhere to all regulations that govern interscholastic athletic programs, including, but not limited to, Federal and State laws, local conference regulations and those imposed by the NCISAA. I understand that local conference rules may be more stringent than the NCISAA and agree to follow the rules of my school and the NCISAA and to abide by their decisions. I acknowledge and understand that participation in interscholastic athletics is a privilege, not a right. I acknowledge that I understand all pertinent rules that apply to my student-athlete and my school. I understand that a copy of the NCISAA Handbook is available at NCISAA.org.
PARENTS, LEGAL CUSTODIANS OR STUDENT-ATHLETES WHO DO NOT WISH TO ACCEPT THE RISK DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS FORM. The student-athlete and parent(s)/legal custodian recognize that participation in interscholastic athletics involves some inherent risks for potentially severe injuries including, but not limited to: serious neck, head and spinal injuries, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal system, serious injury or impairment to other aspects of the body, exposure to viruses or effects to the general health and well-being of the child, and in rare cases death. It is impossible to eliminate all risks. Because of these inherent risks, the student-athlete and his/her parent(s)/legal custodian have a responsibility to help reduce that risk. Participants must obey all safety rules, report all physical and hygiene problems to their coaches, follow a proper conditioning program, and inspect their own equipment daily.
I authorize medical treatment should the need arise for such treatment while I or my child/ward (“student-athlete”) is under the supervision of the member school. I consent to medical treatment for the student-athlete following an injury or illness suffered during practice and/or a contest. I understand that in the case of injury or illness requiring treatment by medical personnel and transportation to a health care facility, a reasonable attempt will be made to contact the parent(s)/legal custodian in the case of the student-athlete being a minor, but that, if necessary, the student-athlete will be treated and transported via any means, including but limited to an ambulance, to the nearest hospital. I further authorize the use or disclosure of my student-athlete’s personally identifiable health information should treatment for illness or injury become necessary.
I understand all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. Further, I understand that if my student is removed from a practice or competition due to a suspected concussion, he or she will be unable to return to participation that day. After that day, written authorization from a physician (M.D. or D.O.) or an athletic trainer working under the supervision of a physician will be required before the student is allowed to return to participation. I also acknowledge that I have received, read and signed the Gfeller- Waller Concussion Information Sheet.
I consent to the NCISAA’s use of the herein named student’s name, likeness, and athletic-related information in reports of contests, promotional literature of the Association and other materials and releases related to interscholastic athletics and grant the NCISAA the right to photograph and/or videotape the participant and further to use the participant’s face, likeness, voice and appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without reservation or limitation. The NCISAA, however, is under no obligation to exercise said rights herein. I further consent to the disclosure, by the member school, to the NCISAA, upon its request, of all records relevant to the student-athlete’s athletic eligibility including, but not limited to, their records relating to enrollment, attendance, academic standing, age, discipline, finances, residence and physical fitness. The student-athlete and parent(s)/legal custodian individually and on behalf of the student-athlete, hereby irrevocably, and unconditionally release, acquit, and discharge, without limitation, the NCISAA its officers, agents, attorneys, representatives and employees (collectively, the “Releasees”) from any and all losses, claims, demands, actions and causes of action, obligations, damages, and costs or expenses of any nature (including attorney’s fees) that the student and/or legal custodian incur or sustain to person, property or both, which arise out of, result from, occur during or are otherwise connected with the student-athlete’s participation in interscholastic athletics if due to the ordinary negligence of the Releasees.
By signing this document, we acknowledge that we have read the above information and that we consent to participation by the herein named student-athlete. We understand that the authorizations and rights granted herein are voluntary and that we may revoke any or all of them at any time by submitting said revocation in writing to the student-athlete’s member school. By doing so, however, we understand that the student-athlete would no longer be eligible for participation in interscholastic athletics.