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WAIVER OF STUDENT ACCIDENT INSURANCE
HOMECOMING PARADE
DATE:_________________
THE CUSD 303 BOARD OF EDUCATION POLICY REQUIRES THAT ANY STUDENT WHO
PARTICIPATES IN PEP ASSEMBLY, VOLLEYBALL, STAR WARS, OR FLOAT BUILDING MUST
HAVE EITHER STUDENT ACCIDENT INSURANCE MADE AVAILABLE THROUGH
COMMUNITY UNIT SCHOOL DISTRICT 303 OR PROOF OF COVERAGE BY ANOTHER
INSURANCE COMPANY.
STUDENT NAME:_______________________________ ID#____________ Year in School:_______
I hereby certify that _______________________________ is insured under
Policy #:_______________________ Name of Insurance Carrier:______________________________
Termination Date:__________________
And that the said student has insurance coverage for any injuries that may occur through his/her
participation in Homecoming activities at St. Charles North High School. I further agree that I will hold
harmless CUSD 303 for any expense that may occur as a result of any injury to my child while participating
in the CUSD 303 SCNHS Homecoming activities.
Signature of Parent/Guardian:________________________________________________
(Turn into Club Advisor or Coach before the Parade)
WAIVER OF STUDENT ACCIDENT INSURANCE
HOMECOMING
PARADE
DATE:_________________
THE CUSD 303 BOARD OF EDUCATION POLICY REQUIRES THAT ANY STUDENT WHO
PARTICIPATES IN PARADE MUST HAVE EITHER STUDENT ACCIDENT INSURANCE MADE
AVAILABLE THROUGH COMMUNITY UNIT SCHOOL DISTRICT 303 OR PROOF OF
COVERAGE BY ANOTHER INSURANCE COMPANY.
STUDENT NAME:_______________________________ ID#__________________
I hereby certify that _______________________________ is insured under
Policy #:_______________________ Name of Insurance Carrier:______________________________
Termination Date:__________________
And that the said student has insurance coverage for any injuries that may occur through his/her
participation in Homecoming activities at St. Charles North High School. I further agree that I will hold
harmless CUSD 303 for any expense that may occur as a result of any injury to my child while participating
in the CUSD 303 SCNHS Homecoming activities.
Signature of Parent/Guardian:________________________________________________
(Turn into Club Advisor or Coach before the Parade)