| This is to certify that I have elected not
to cover my son or daughter with school insurance for the school day or
for extra-curricular activities. I certified that I have adequate
insurance coverage. I understand that should my son or daughter
require insurance coverage must be provided by personal policies, or I
will pay for necessary expenses from my personal resources. I
understand that athletic insurance is a requirement for students
participating in athletics, band, dance team, or NJROTC and can not be
waived. |