Physical Waiver Note

I _______________________________ will not consent to the physical examination

of my child ("Student") _________________________________.  I acknowledge that 
in so doing I voluntarily assume the risk that my student will engage in 
interscholastic athletic competition without having undergone a physical 
examination to determine wherther the Student is physically fit to participate 
in athletics.  I do not want my Student to have a physical evaluation for the following reason:











____________________________________________________      _________________
signed                                                     dated