JACKSON COUNTY CENTRAL COMMUNITY EDUCATION

YOUTH SPORTS AGE WAIVER FORM

I, the parent, request that my son/daughter be considered one grade higher than his/her true grade level for consideration in youth sports league placement.  I realize the inherent and potential danger of such a decision with respect to the nature of the sport specified on this document.

My reasons for advancing him/her one grade level is as follows:  ________________________________________________________________________

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In consideration of accepting my waiver request, I hereby, for myself, and my dependent, waive and release any and all rights and claims against JCC Community Education and the JCC School District, its agents, employees, and sponsors for any and all injuries, circumstances, and outcomes affecting my son/daughter during the youth sports program specified below, sponsored by JCC Community Education.

SPORT: ___________________________________AGE DIVISION _______________

CHILD’S NAME: ____________________________DOB: ____/_____/__________

PARENT’S NAME: _______________________________PHONE #: ______________

PARENT’S SIGNATURE:  ____________________________DATE: ____/____/_____

THIS WAIVER IS APPROVED:   YES __________       NO ___________

SIGNED BY RECREATION DIRECTOR _______________________________

DATE:  ____/_____/______________

SIGNED BY C.E. COORDINATOR    ___________________________

 DATE:  ____/_____/______________