CHET-SE PE Registration and Release Form
School Year 2024 - 2025 

I, the undersigned parent/guardian, do hereby grant permission for the child(ren) listed on this page to participate in CHET-SE PE. In order that my child/ward may receive the proper medical treatment in the event that he/she sustains injury or illness during any CHET-SE activity, I hereby authorize a supervising adult to obtain or provide medical treatment for my child/ward for such injury or illness during the CHET-SE activity, and I hereby hold CHET-SE, as well as its representatives, harmless in the exercise of this authority. I hereby release from any liability CHET-SE and all adult supervisors and class helpers in the event of any accident en route to or during activities. I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my child/ward for physical illness or injury that he/she may sustain during any CHET-SE activity.

I also understand that the PE Program includes activities such as running, jumping, stretching, and other physical exertion to benefit the students. Understanding that there is always a possibility that my child/ward may sustain physical illness or injury, I acknowledge and understand that my child/ward is assuming the risk of injury or illness by his/her participation, and I further release CHET-SE and its representatives from any claims for personal illness or injury that my child/ward may sustain during PE activities. I am aware that if my child/ward has a medical condition that prevents or prohibits him/her from participation in any PE activity (i.e. running, jumping, stretching), I must notify the PE Coach and PE Director on the day of participation. 

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION 

(To be contacted if parent/guardian is not available)

Please initial that you have read and understand each of the following statements: 

I understand that PE is NOT a drop-off event and I agree to remain on the premises to be available in the event that I am needed to care for my child in ANY way. If I must leave the park, I will let the coach and PE Director know which adult remaining at the park has agreed to take responsibility for my child/ward in my absence as well as provide his/her contact number. 

I understand that should my child/ward be disruptive to the class, he/she will be asked to sit out and/or leave and will be under my supervision for the remainder of PE. 

I understand that the PE Coach or Director will speak with me directly if there is a behavior concern with my child/ward.

I understand that if I have any concerns, it is my responsibility to speak with the coach directly. If things are not resolved, I will speak with the head coach for my child’s group. If things are still not resolved, I will approach the PE Director. My final place of appeal, should the matter not be resolved, is the CHET-SE Board. 

I am solely responsible for the safety, medical and disciplinary care of my child. I am providing the following medical information only for the purpose of making others aware:

If my child/ward needs advanced medical intervention (such as but not limited to an epi-pen or inhaler), I will remain close by to intervene should the need arise for my child/ward to have assistance. 

I understand that participation in CHET-SE PE (except as a guest) REQUIRES me to register with CHET-SE, which is a separate online registration process, requiring a separate payment. 

Have you already paid the $25 PE Registration Fee? If so, please indicate how you paid (cash or check) and to whom you gave the fee.

Have you prepaid for any PE days? If so, what amount did you pay?

CHILD(REN)'S INFORMATION
     For EACH child, please type: 

• Name
• DOB
• PE Class: Squirrel (ages 4-5), Coyote (6-7), Cat (8-10 girl), Bear (8-10 boy), MS (11-13), or HS (14-18) 
• M (Male) -or- F (Female), 
• Age of each child on September 30, 2024