Dexter Iowa Community Site

Consider this quote from Abe Lincoln

"America will never be destroyed from the outside. If we falter and lose our freedoms, it will be because we destroyed ourselves."

WILDCAT YOUTH SOFTBALL PROGRAM 2009

GOOD CONDUCT POLICY AGREEMENT FOR STUDENTS & PARENT(S)/GUARDIAN(S)

I _________________________ understand and agree to abide by the rules and regulations set forth in the WCV Good Conduct Policy. If I violate any of these rules/regulations, I am fully aware of and understand that disciplinary actions may be invoked. As Parent(s)/Guardian(s) we understand what is expected of our child when participating in extracurricular activities and that disciplinary actions may be invoked for any violation.

Signed ___________________________ Date ______________
Parent or Guardian

Signed ___________________________ Date ______________
Student Athlete

Medical Information

Student Name: _________________________ Age: ______ Grade: ______

Parents/Guardians Name: __________________________

Address: _______________________________ City:__________________ State:_____

Phone: ( )-____-_____ Cell Phone: ( )-____-_____

In case of emergency, please contact the following

Name: __________________________ Phone: ( )____-_____

Name: __________________________ Phone: ( )____-_____

Please list the doctor and hospital that you designate for an emergency situation

Doctor: ____________________________ Phone: ( )____-_____

Hospital: ___________________________ Phone: ( )____-_____

Provide company name and policy number of insurance carrier

Name: _________________________________ Policy #: _________________

I/We ___________________________ understand that there are risks participating in sports. I/We agree not to hold coaches, assistants, officials, or players responsible for injuries incurred by our child. I/We give permission to our child listed above to participate in softball during the 2009 season. In case of injury or sickness, I/We assume full responsibility for all medical bills.

Signed ________________________________ Date ________________
Parent/Guardian