INSURANCE COVERAGE STATEMENT

The USD #402 Board of Education does not provide accident/health insurance coverage for individuals participating in interscholastic activity programs. If insurance is desired, it is the responsibility of the parents to provide such coverage.

The USD #402 Board of Education does provide catastrophic coverage for students injured while practicing for, participating in, or traveling directly to and from activities under the jurisdiction of the K.S.H.S.A.A. The catastrophic injury policy provides protection only in cases of severe injury. There is a $25,000.00 deductible clause in the insurance policy. Claim forms will be available in the principal's office of the school that your child attends.

I hereby certify that ______________________________________

(Student's name) has my permission to participate in interscholastic activities while a student in the Augusta School System.
Also, I understand that USD #402 does not carry any type of insurance (other than catastrophic) to cover injury to my child while participating in these activities.

_____________________________________ ____________________________

(Parent or Legal Guardian's Signature) (Date)

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PARENTAL CONSENT FOR USE OF PHOTOS

ON DISTRICT WEBSITE

I, ___________________________________ (please print), custodial parent/guardian of _________________________________________ (please print) do hereby give my permission for USD 402, Augusta Public Schools, to use photographs of the above-named child as indicated below by my signature. I understand that the child will not be identified by name.

Date______________________

Signature____________________________________

Printable version of this form