Intramural Permission Slip

Intramural Permission Slip

In order to participate in an intramural you must have a signed permission slip.

I the undersigned student aged 18 or over, or the undersigned parent or lawful

guardian of________________________________, a minor, do hereby consent

(name of student)

to the participation of ______________________________ in the_________________

(name of student) (name of activity/event/sport ,etc)

program offered by________________________________. I/we understand that

(school name and date(s) of activity)

participation in the program or event is not required and that participation is voluntary.

I/we understand the activities of this program or event, its rules and requirements

and its potential risks. I/we accept these conditions and hereby grant permission for

my/our child’s participation.

I/we hereby forever release the Town of Braintree, the Town of Braintree School Department and it officers, employees, agents and volunteers from any and all claims for damages with respect to or in connection with all known and unknown personal injuries incurred by my/our child while participating in the program or event except for damages caused solely by the negligence of the Town of Braintree School Department or its officers, employees, agents or volunteers.

I/we hereby agree to indemnify and hold harmless the Town of Braintree, the Town of Braintree School Department and its officers, employees, agents and volunteers with respect to any such claims for damages which are caused solely by the negligence of the Town of Braintree, the Town of Braintree School Department or its officers, employees, agents or volunteers.

Parent/Guardian Signature:________________________________

Date:_________________________________________________

NAME: _____________________________________

ADDRESS: ________________________________________

TELEPHONE: ______________________________________