Sample Intramural Permission & Acknowledgement of Elements of Risk Form

This sample form is intended to serve as a guide for stakeholders to create a form that aligns with the policies and procedures in their respective school division/school.


Intramural activities are defined as school-sponsored physical/recreation activities that occur outside the student's instructional time and are not competitions against other outside teams/groups. They may include Sports Games and Sport Imitations, Low Organization Activities, Drop-In Physical Activities, and some Special Events and Clubs.

(Include the list of expected intramurals for the school year here.)

Elements of Risk

In all physical activities there is an element of risk. Accidents/injuries may result from the nature of the activity and can occur without any fault on either the part of the student, or the school division or its employees or agents or the facility where the activity is taking place. Injuries may range from minor sprains and strains to more serious injuries (for example, concussion). Participants assume this risk but reduce the chance of an accident/injury occurring by carefully following instructions at all times during the activity.

I acknowledge and have read the Elements of Risk and I give my child/ward permission to participate in intramurals.

Parent/Guardian Signature:
Question Mark


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