I, , being the legal parent/guardian of , do hereby give the right and power to the school official(s) of to authorize medical treatment, care and services, to discipline and make whatever decisions necessary for my child's welfare in the discretion of said official(s) while my child is participant of at for the period of . I understand that this authorization in no way relieves me of any financial or other obligations related to any decisions made by the above school official(s).

I hereby appoint the Board of Education as my agent for the purposes of obtaining medical treatment in the event of injury. I agree to be responsible for all medical expenses incurred in connection therewith. In the event the Board of Education incurs expenses for medical treatment, then and in that event I agree to reimburse said Board of Education in full.