Fillable Acknowledgement of Insurance Requirements by Parent or Guardian (Alvin Community College)

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Acknowledgement of Insurance Requirements by Parent or Guardian (Alvin Community College)

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Student-Athlete Name _________________________
Sport _________________________
Acknowledgement of Insurance Requirements by Parent or Guardian
I, _____________________________________________, as parent, guardian or legal representative, attest that
______________________________________ has insurance coverage under an active, valid insurance policy
either under my parent, guardian, legal representative or an individual policy for injuries that occur during my
participation in intercollegiate athletics at Alvin Community College.
If there is a material change in coverage or expiration of coverage, I agree to notify the Alvin Community
College Department of Athletics of this development and update the insurance information I have on file with
the Alvin Community College Department of Athletics.
Parent or Guardian Signature__________________________________ Date________________________
Notification of NO Insurance Coverage
I, _____________________________________________, as parent, guardian or legal representative, attest that
______________________________________ has no insurance coverage in force, and agree to notify Alvin
Community College Department of Athletics if a change occurs to update the insurance information I have on
file with Alvin Community College.
Parent or Guardian Signature__________________________________ Date________________________
THIS FORM MUST BE SIGNED AND RETURNED TO THE ALVIN COMMUNITY COLLEGE ATHLETIC OFFICE PRIOR
TO PARTICIPATION IN ANY SPORT.
Return to:
Alvin Community College
Athletic Office, G-133
3110 Mustang Road
Alvin, TX 77511
IN ADDITION YOU MUST INLUDE A COPY (FRONT AND BACK) OF YOUR CURRENT INSURANCE CARD. YOU
MUST ALSO FILL OUT AND TURN IN A NEW ATHLETIC INSURANCE INFORMATION FORM WHICH SHOULD BE
TYPED.
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Acknowledgement of Insurance Requirements by Parent or Guardian (Alvin Community College)

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Completed 27 July 2020

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