Extracurricular Athletics Consent
This Consent Form must be signed annually by parents/guardians in order for their children to participate.
Dear Parent: Here is some basic information you need to be aware of in order for your child to participate in extracurricular
athletics. Please consult your Parent/Student Handbook or the Athletic Director for more information. After reading this
carefully, please sign the consent at the bottom of this page. Thanks for your support.
PHYSICAL EXAMS*
Temple Academy seeks to provide all students who desire to participate in athletic events the safest conditions of participation. Therefore, our
policy requires every child seeking to participate in extracurricular athletics to have a complete physical exam. Students in grades 5-8 must have a
physical every other year, and students in grades 9-12 must have a recent physical examination prior to the start of their sport season, every year.
Parents are responsible for the cost of these exams. A Medical Questionnaire must be submitted by the parent/guardian at the beginning or each
year. Any athlete who has sustained an injury, or a health problem requiring a physicians’ care since the student’s last complete physical, must
receive a medical release from the physician before the student may return to athletic participation.
SPORTS ACCIDENT INSURANCE
All Temple Academy athletes are covered by the Sports Accident Insurance offered through the ACSI, regardless of any coverage they already have
purchased.
EMERGENCY CARE
In case of emergency illness or accident the child is given first-aid and the parents are notified. If the parents or the child’s doctor cannot be
located, the child will be taken to the Emergency Room of their choice, if available. Temple Academy does not assume responsibility for the
payment for the hospital, doctor, or ambulance fees. Sports Participation Emergency Medical Cards will be on file with the coaches.
DROP-OFF AND PICK-UP OF PLAYERS
Students should not be dropped off more than 15 minutes prior to the activity and must be picked up within 15 minutes after the activity. Please
remember our coaches are volunteers and prompt pick up is appreciated.
RESPONSIBILITY FOR DAMAGES
Athletes will be liable for any lost or damaged school-issued supplies and for damages to any school facilities, whether Temple Academy’s or other
schools.
SPORTSMANSHIP
Parents are expected to help model the kind of sportsmanship we want to see from our student athletes. An athletic event is an opportunity for
the positive Christian witness both to our own children and to the community. Parents are asked to refrain from any negative demonstrations,
activities, or speech which would hurt our Christian testimony in any way.
SPORTS FEE
Sports fees will be announced. Fees will be charged for each child per sport to help defray the costs of the program. They are due before uniforms
are issued or arrangements must be made with the bookkeeper. Parents are required to perform four (4) hours of volunteer time or be charged
$10 an hour for unmet hours.
WARNING OF INHERENT RISK THROUGH PARTICIPATION IN ATHLETICS
Participation in athletics, especially contact and collision type sports can result in bodily injury to the athlete. The Temple Academy Coaching Staff
will take every reasonable precaution to ensure that athletes are protected from injury.
Student Name: ______________________________________________ Grade: ______________ Today’s Date: _______________
Date of Last Complete Physical: ______________________ Performed by: ______________________________________________
PARENT CONSENT:
I give my permission for the child listed above to participate in Temple Academy extracurricular athletics and to travel with their team by bus, van
or parent automobile. I understand and will support the school’s policies governing the extracurricular program. I understand the inherent risk of
participation in athletic activities and agree to hold harmless and without fault Temple Academy, all staff hereof and any other school
representative for any injury to my son/daughter which may arise out of the course of said activities.
____________________________________________________
Father/Legal Guardian Signature
Date
_________________________________________________
Mother/Legal Guardian Signature
Date
*According to the above policy, my son/daughter ___ DOES ___ DOES NOT need a physical exam this year to participate in the
extracurricular program at Temple Academy. I have completed the Medical Questionnaire required.