Liberty Girls Lacrosse Club
Parents’/Guardians’ “Agreement to Disclose
Significant Academic Problems” Form
We agree as parents/guardians to disclose to the Head
Coach any significant academic problems my child might be
experiencing. I realize this may result in the club’s suspension
of my child indefinitely should they feel the child’s involvement
in the club will deter from correcting such academic problems.
Name (print) _____________________ Signature
_________________
Name (print) ____________________ Signature
__________________
Child’s name (print) _______________________________
This is in good faith and the club and its officers agree to
keep any such information strictly confidential.
Parents’/Guardians’ “Agreement to Disclose
Significant Academic Problems” Form
We agree as parents/guardians to disclose to the Head
Coach any significant academic problems my child might be
experiencing. I realize this may result in the club’s suspension
of my child indefinitely should they feel the child’s involvement
in the club will deter from correcting such academic problems.
Name (print) _____________________ Signature
_________________
Name (print) ____________________ Signature
__________________
Child’s name (print) _______________________________
This is in good faith and the club and its officers agree to
keep any such information strictly confidential.
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