WESTCHESTER FENCING CLUB

Parent Permission Form (2004/2005)

Student’s Name: ______________________________________________________

This form must be signed by both the student and parent/guardian and returned to Mr. Moss before the student may participate in any practice session or tournaments. 

Parent or Guardian’s Permission

I hereby give my consent for the above named student to receive lessons and practice competitive fencing as a member of the Westchester Fencing Club. 

I understand that although the practice sessions are held at Spring Branch ISD facilities, the Westchester Fencing Club is a parent/community sponsored club, and is not a Spring Branch Independent School District sponsored program.

The undersigned agrees to be responsible for the safe return of all athletic equipment issued by the Westchester Fencing Club to the student.

I understand that it is my responsibility to arrange for transportation for my child at the end of the practice sessions, and that the Westchester Fencing Club is not responsible for the supervision and safety of this arrangement if transportation is not provided in a timely manner.

I grant permission for my child’s photograph and name to appear in educational, media and commercial publications.  Some examples of these are the Westchester yearbook, the display case in the Westchester Dining Hall, the Westchester Fencing Club website, local media newspapers and local television stations.

I agree to report to a representative of the Westchester Fencing Club any information regarding my child’s medical history that may affect his/her health during practice sessions or tournaments.

I understand that even though protective equipment is worn by the student whenever needed, the possibility of an accident still remains.  The representatives of the Westchester Fencing Club and the Spring Branch ISD do not assume any responsibility in case an accident occurs.

If, in the judgment of any representatives of the Westchester Fencing Club, the above named student needs immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given to said student; and I do hereby agree to indemnify and hold harmless the Westchester Fencing Club and any club representative from any claim by any person whomsoever on account of such care and treatment of said student.

I have read the regulations cited above and agree to follow the rules.

Student Signature______________________________________________  Date:  _________

Parent/Guardian Signature______________________________________  Date:  _________

Street Address  ________________________________________________________________

City/State/Zip _________________________________________________________________

Home Telephone _______________________ Business Telephone ______________________