RIPCOA Assumption of Risk 20-21

PRINCIPALS’ COMMITTEE ON ATHLETICS GRADES 6 -8

Acknowledgement, Authorization and Assumption of Risk Form Academic Year ___________

The undersigned, being an adult student-athlete or parent/legal guardian of the undersigned minor prospective student-athlete, hereby acknowledge that said student seeks to participate in a student sports program sponsored by the Principals’ Committee on Athletics Grades 6 – 8. The undersigned specifically assert that said student-athlete will comply with the rules and regulations governing athletics participation of the Principals’ Committee on Athletics Grades 6 – 8; the undersigned hereby authorize the release of information and reports concerning the academic standing, medical condition, financial aid, attendance, residency and the disciplinary record of the undersigned student to Principals’ Committee on Athletics Grades 6 – 8 for the purpose of enforcing the rules and regulations of the athletics program; that they are aware that the athletic participation requires physical fitness; that the student possesses such fitness; and that some risk is involved in sports participation. ​For sports involving helmets, we acknowledge the following WARNING: Do not use any helmet to butt, ram or spear an opposing player. This can result in severe head, brain, or neck injury, paralysis or death to you, and possible injury to your opponent. There is a risk these injuries may also occur as a result of accidental contact without intent to butt, ram or spear. NO HELMET CAN PREVENT ALL SUCH INJURIES.

We/I acknowledge that by entering any premises and participating in sports programs sanctioned by RIPCOA there are risks to the student-athlete and to those with whom the student-athlete interacts of exposure, directly or indirectly, to a communicable disease(s) including, but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, “Covid-19”, and/or any mutation or variation thereof.

Now, therefore, pursuant to Rhode Island General Laws 7-6-9, as amended, the undersigned, in consideration of participation in a Principals’ Committee on Athletics Grades 6 – 8 sports program, herein grants to its officers, directors, trustees, agents (to include but not limited to the local School Committee or its parochial or private equivalent), servants and employees, a waiver of liability as regards to participation in the sports program sponsored by the Principals’ Committee on Athletics Grades 6 – 8.

The undersigned specifically acknowledges that a risk of injury exists and assume said risk with respect to practicing for or participating in any contest or exhibition of an athletic or sports matter sponsored by Principals’ Committee on Athletics Grade 6 – 8.

School (Print)

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City or Town (Print)

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Name of Student (Print)

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Signature of Student

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Age of Student Student’s DOB Current Grade

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Name of Parent/Guardian (Print)

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Signature of Parent/Guardian

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Date of Signature

<NOTARY SEAL>

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Signature of Notary Public / Commission Expires

(This form ​must​ be completed by ​all student-athletes, regardless of grade​, intending to participate in any Rhode Island Principals’ Committee on Athletics sport after Aug.1, 2020. All minor students must sign and have a parent or legal guardian also sign. All forms are to be notarized and returned to the school of record. Failure of a school to provide a duly executed form will cause the athlete to be declared ineligible.) © RIPCOA Aug 2020