The form below must be completed if any of your team members plan to attend the Workshop at USD. You may bring this form with you to the Workshop.

Otherwise, this form must be received by December 15, 2004. Please send this completed form promptly - I hate having to track down the coaches who have not sent submitted it on time.

I need to have one completed insurance form for each head coach. That means, for instance, that all teams from Mount Carmel High School are covered by one form. However, if both Division B and C teams are from the same school (Guajome, for example) please use one insurance form for all Division B teams and another form to cover all Division C teams from that school.

Mail to : Liz Jablecki
2759 Costebelle Dr.
La Jolla, CA 92037-3518

San Diego County Science Olympiad

Coach___________________________ School__________________________

Address________________________________________________________

District_________________________ County_________________________

___________________________ School District will provide insurance to cover liability for Science Olympiad team members and coach(es) participating in the Workshop at the University of San Diego on November 13, 2004 and in the Regional Science Olympiad Competition to be held on Saturday, February 5, 2005 at the University of San Diego with the University of San Diego as an added insured. Also, should your team qualify for and decide to attend the State Competition, on a Saturday in April, 2005, this insurance may apply.

  In addition, the head team coach agrees to be responsible for any damage done, accidentally or purposefully, during the competition by any member of his/her team, coaches, parents, or other students with the team.

Practically speaking, this means that the team coach should have a form similar to this one signed by each participant and his/her parent or guardian. If some damages are incurred, we will send the bill to the coach who can either:

a. pay the bill, then collect from the offending student(s);

b. have the student(s) pay the bill directly.

If the coach does not accept this responsibility by signing this form, this form and the Registration fees will be returned, and the team(s) will not compete this year. This is NOT optional.