STATEMENT OF INSURANCE COVERAGE. Grantee certifies and agrees that they have all required insurance coverages as stated in the grant agreement, which will be in effect for the entire term of the agreement.
STATEMENT OF INSURANCE COVERAGE. □ My child is covered by medical insurance under my own (Student’s Name – Please print or type) policy which is with . This insurance will cover my child while participating in extra-curricular activities for the school year . □ I currently do not have a health insurance policy and will secure medical insurance through (Signature of Parent/Guardian) (Date) I have received and read the following required forms for my child to participate in Charleston CUSD #1 C.U.S.D. #1 interscholastic athletics or intramural athletics. Please check: □ I have received and read a copy of Board policy 7:305, Student Athlete Concussions and Head Injuries.
