INSURANCE VERIFICATION FORM

HEATH HIGH SCHOOL

300 LICKING VIEW DR.

HEATH, OH 43056

740-788-3300

Dear Parent / Guardian,

Your son or daughter will be participating in interscholastic sports this year. It is important that we know whether he or she has adequate insurance coverage.

I cannot urge strongly enough that you check your insurance policy now to make sure you are covered, especially for football protection and emergency room visits. Occasionally we find too late that such is not the case.

Please take time to see that you have adequate insurance coverage for your son or daughter. If you do not, and it is past the October 1 deadline, please see your agent about obtaining sufficient coverage. Your son or daughter cannot participate until we have this information.

Sincerely,

Ellis E. Booth, CAA

Athletic Director

I hereby verify that __________________________________________ has adequate insurance protection and therefore the Heath City School District will not be financially liable for injuries suffered during athletic related activities.

___________________________ ______________________________________

Date Parent / Guardian Signature