New Paltz Central High School<= span style=3D'font-size:24.0pt;mso-bidi-font-size:10.0pt;color:navy'>=

New Paltz Central School District . <= st1:Street w:st=3D"on">196 Main Street, New Paltz, NY 12561

= &nb= sp; = Tel. (845) 256-4100 . Fax (845) 256-4109 . E-mail: npchs@newpaltz.k12.ny.us

Barbara Clinton = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = Dennis DiBari

Principal = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; Assistant Principal

New Paltz Ultimate Frisbee Club Permission Slip

Name:___________________= _________________

&= nbsp; &nbs= p; Your child has indicated a desire to participate in the Ultimate Frisbee Club for the current school year. Ulti= mate Frisbee, though technically a low contact activity, involves a high degree = of physical activity and can result in injury, sometimes serious injury. With = the parent/guardian signature, the parent/guardians authorize the club advisor = to seek medical aid if their child is injured. Your Board of Education feels t= he District and parents share in the responsibility of the young people participating in club activities. Parents/guardians must assume responsibil= ity in the event of injury to the extent that their own health insurance and accident insurance acts as a “primary carrier”, the District’s accident and health insurance will assume responsibility as the secondary carrier.

&= nbsp; &nbs= p; Being a club activity, participation in Ultimate Frisbee Club does not require an Athletic Health History= form and physical examination. However, given the nature of the club, parent/guardians may want to ch= eck with their child’s physician before allowing them to participate. The club advisor does require a par= ent permission form (see below) to allow participation.

&= nbsp; &nbs= p; Students involved with this and any other extracurricular activity are subject to academic and behavioral eligibility requirements.

-------------------= ---------------------------------------------------------------------------= ---------------------

I hereby give my consent for __________________________________ to participat= e in Ultimate Frisbee Club for the current school year. I agree that in case of injury or accident to my child while participating in this activity, I will assume full responsibility for any expenses covered by my own hospitalizati= on insurance before requesting the school district to assume additional costs = to the extent of its insurance coverage.

_______________________ __________________________ _____________

Signature of Parent/Guardian = Signature of Student = &nb= sp; Date