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Participation Waivers & Authorization Forms

These forms have been formatted with space at the top to allow for printing on district letterhead.

Agreement For Activity Participation (Students K-12)

Used for all Student Activities, Clubs, and/or Special Classes (including after-school programs or classes involving special risks of harm or injury, including ROP/work experience classes)

Before a K-12 student participates in extracurricular or "risky"/"dangerous" curricular classes, this form should be executed acknowledging the risks associated with such activities (including risks of injury during transportation to and from off-site events), the student’s and parent’s agreed compliance with districts safety rules, and the authorization to administer emergency care in the case of injury.

MS Word (.doc) available in the following languages:

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Contract For Adult Activity Participation

Used for all Adult Education/Vocational Rehabilitation, etc. Classes involving special risks of harm or injury, including off-site training or work experience activities

Before an adult education student participates in a class or program involving potentially "risky"/"dangerous" activities, this form should be executed acknowledging the risks associated with such activities (including risks of injury during transportation to and from off-site events), the adult student’s agreed compliance with districts safety rules, and the authorization to administer emergency care in the case of injury.

MS Word (.doc) available in the following languages:

MS WordEnglish

Agreement For Team Participation

Used for all Team Sports (CIF and Intramural), Band, Cheerleading, and Dance Team

Before a student tries out for, participates in practices or training sessions, or is actually involved in team/group events, this form must be signed acknowledging the risks associated with such activities (including risks of injury during transportation to and from off-site events), the student’s and parent's agreed compliance with districts safety rules, and the authorization to administer emergency care in the case of injury.

The form also requires information regarding statutorily required insurance the student must provide, absent financial circumstances requiring that such insurance/coverage be obtained through other sources.

MS Word (.doc) available in the following languages:

MS WordEnglish

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MS WordHmong

MS WordPunjabi

MS WordRussian

MS WordSimplified Chinese

MS WordSpanish

MS WordTagalog

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Sports Physical Examination Form

Used for all Team Sports (CIF and Intramural), Band, Cheerleading, and Dance Team

Before a student tries out for, or participates in, any of the listed extra-curricular activities, the student must have (a) a parent or legal guardian complete the medical history, and (b) a medical doctor, doctor of osteopathy, or doctor-supervised nurse practitioner or physician’s assistant conduct the examination and execute the form.

MS Word (.doc) available in the following languages:

MS WordEnglish

MS WordHindi

MS WordHmong

MS WordPunjabi

MS WordRussian

MS WordSimplified Chinese

MS WordSpanish

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Student Field Trip Authorization

Used for all In-State Field Trips (Whether or not Overnight)

While the Education Code provides immunity for field trip activities, the form requires parents to acknowledge the immunity laws, and the risks associated with the activity, as well as providing authorization to administer emergency care in the case of injury.

MS Word (.doc) available in the following languages:

MS WordEnglish

MS WordHindi

MS WordHmong

MS WordPunjabi

MS WordRussian

MS WordSimplified Chinese

MS WordSpanish

MS WordTagalog

MS WordUkrainian

MS WordVietnamese

Student Field Trip (Outside California) Authorization

Used for all Out-of-State/Foreign Field Trips

In addition to the issues covered under the standard field trip form, this form also notes the limitations on payment for travel-related costs and expenses and the risks of financial loss to the student/parent if the trip is cancelled for some reason.

MS Word (.doc) available in the following languages:

MS WordEnglish

MS WordHindi

MS WordHmong

MS WordPunjabi

MS WordRussian

MS WordSimplified Chinese

MS WordSpanish

MS WordTagalog

MS WordUkrainian

MS WordVietnamese