AIS Core Sports Permission Form 2007-2008

Participant Info:

name in full 
print/romaji
dob
phone
address
email
check your current experience level 
beginner intermediate advanced 
is there any applicable medical information that staff should be aware of?

========
ais student / parent / staff
class         child name       dept

============

Emergency Contact Info:

name in full
print/romaji
relationship to participant
parent grandparent other:___________________
phone / cellphone

Rules and Regulations:

Skate club / core sports is open to AIS students from grade 2 and up. There may be drop-in lesson times and other events for parents and staff(20+).
All participants must bring this signed permission/release form before participating in an AIS core sports activity or using the mini ramp. No one may skate when the ramp is unsupervised.

Skateboard students must wear a helmet and wrist guards and beginners are encouraged to wear all the safety gear including elbow and knee pads. Participants must respect the skate leaders, instructors, school and property or they may be asked to leave. In case of rain, skate club will continue with alternate activities but the drop-in lessons will be cancelled. Skate club, core sports, and drop-in lessons may be cancelled occasionally due to extenuating circumstances.

Release Statement:

1.I understand that AIS skate club core sports participants must be:
(a) AIS students in grade 2 or higher, 
(b) AIS staff or parent, or 
(c) 20 years and older with special approval 
to be eligible to participate in AIS skate club, core sports, or drop-in lessons.

2. I understand, acknowledge, and agree that participants must follow the AIS, skate club, and core sports rules of conduct and obey respect the skate leaders, instructors, school and property or they may be asked to leave. I agree to reasonable use of participant photos and video footage within core sports activities in promoting the sport, school, and program.

3. I understand, acknowledge, and agree that skateboarding and other core sports are dangerous activities and participation and even observation can result in injury, disability, death or personal property damage.

4. In the event of an accident or illness, I authorise a skate leader, instructor, or AIS staff member to consent to IMMEDIATE FIRST 
AID MEDICAL CARE, any X-ray, examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care for the participant which is deemed advisable by and to be rendered under the general or special supervision of any physician, surgeon, or dentist, at any hospital, dental office, or elsewhere. I also authorise to engage such treatment and agree to pay the appropriate fees for such service and treatment.

I, as the birth parent/legal guardian of the participant, have read, 
understand, and had opportunity to ask questions, and consent to 
the terms above and to the minor becoming a participant.

Parent/Legal Guardian Signature 
_____________________________ Date ____ /____ /____

Relationship to participant ______________________________ 

Or 
 
I, as an adult, have read, understand, and had 
opportunity to ask questions, and consent to 
the terms above and to becoming a Participant.


Adult participant age 20 or older:

SignatureX______________________________ Date ____ /____ /____ Birth 


hanko?

Ashiya International School 4-1 Yoko-cho, Ashiya-shi, Hyogo, 659-0034
http://aischool.ed.jp phone: fax: