Vandalia-Butler City Schools

Athletic Department

AWARENESS FORM

___________________________________ ___________________

[name of student] [telephone #]

___________________________________

___________________________________ __________________

[address] [year of graduation]

I have in my possession, read, and understand the Athletic Code of the Vandalia-Butler City Schools.

By signing this form, I agree to abide by the rules and the standards set forth in this code as adopted by the Board of Education while attending Butler High School grades 9 through 12/ or Vandalia-Butler Middle Schools. I understand that a violation of any of the OHSAA or V-B School’s regulations will result in action as prescribed. Furthermore, any act in violation of the Athletic Code that occurs outside of the school setting which is brought to the attention of the school authorities, will be prosecuted under the Athletic Code following due process, by referring the athlete to the Principal and/or Director of Athletics for a determination.

I have been warned and I am aware that there is a risk of being injured that is inherent as a result of participating in any sport.

_____________________________ _______________________

[signature of athlete] [signature-parent/guardian]

_____________________________ _______________________

[date] [date]