Eau Claire North Powerlifting Participation and Equipment Use Form

1.) I agree that I understand the nature of powerlifting and its risks. I fully accept these risks and am voluntarily willing to participate in the North High School Powerlifting Program. 2.) I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE North High School, the WHSPA, and/or the officers, directors, coaches, administrators, clubs, members, volunteers or participants of the North High School Powerlifting Program. 3.) I understand that coaches of the North High School Powerlifting Program have gone through all of the necessary procedures to be approved by the Eau Claire Area School District, including a thorough background check. I will follow the instruction and guidance of the coaches, within reason, to the best of my abilities. 4.) I will follow the weightlifting program provided to me by the coaches of the North High School Powerlifting Program. I will also attend the majority of practices (greater than 50%) and mandatory practices prior to competition. Failure to do so will result in being removed from competition. The only exception is an excused absence, in which the coaches must be notified beforehand or as soon as possible in the case of an emergency. Terms of Equipment Rental: If I choose to rent powerlifting equipment from the North High School Powerlifting Program, I am subject to the following conditions: 1.) All items must be checked out and returned through one of the North High School Powerlifting coaches. Any items that are taken without permission and documentation will be considered stolen. 2.) I undertake all financial responsibility for loss, damage, or theft of the rented item. 3.) If I fail to return an item rented under my name, I realize that an academic hold may be placed on my record until the item is either returned or the cost for that item is covered. Insurance Waiver I certify that I have adequate insurance coverage on the above-named student to cover medical expenses in the event of a Powerlifting accident or injury, and that I also have the option of enrolling in a school-sponsored student accident insurance plan. I also understand that I have the right to waive enrollment in the school-sponsored plan if I believe that the above-named student is adequately covered by my current insurance carrier.

Student Name: _________________________________________________Year of Graduation: 20-_____ Parent(s) Name(s) _______________________________________________________________________ Address: _________________________________City: ______________________ Zip Code: __________ Birth Date: ___________
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Health Insurance Carrier: _____________________________Policy Number: _______________________ Signature By signing this form, I am attesting to the fact that I understand and agree to all conditions set forth on this form, that if I have not understood any information, I have sought and received an explanation, and am fully aware that I am granting permission for the above-named student to participate in the North High School Powerlifting Program. _______________________________ __________ Parent/Guardian Signature Date _____________________________ ___________ Student-Athlete Signature Date