I give my child permission to travel unaccompanied to and from the James P. Sullivan Memorial Basketball Camp on September September 22, 23 or 24, 2004. I agree not to hold the Board of Education or any of its employees responsible for any injuries or expenses resulting from any injury that my child may incur while engaged in this event. I also agree to inform the PSAL of any change in my child’s medical or physical condition which may develop after this document is signed.

STUDENT’S NAME (PRINT) _________________________________________________

EMERGENCY CONTACT TELEPHONE # _______________________________________

STUDENT’S SIGNATURE _____________________________ DATE ________________

PARENT/GUARDIAN SIGNATURE ___________________________ DATE ___________

This form must be returned by September 19, 2003, close of business to the Athletic Director at your son’s/daughter’s school.

Players nominated must meet the academic eligibility requirements of the PSAL and have a current medical form and a parental permission form on file at their school. By allowing their athletes to participate, coaches attest to having all applicable forms on file at their respective schools.