Consent Form for Release of Student To a Middle/High School Student
Name of Elementary Student
Grade of Elementary Student
Name of Middle/High School Student
Grade of Middle/High School Student
Please enter the middle or high school student's relationship to the elementary school student.
Name of Parent/Guardian
Parent/Guardian, and the students named above hereby acknowledge and agree to the terms and conditions set forth below:
1. Departure from School Grounds: After the elementary student has been released to the middle/high school student, the students may not remain on school grounds. The students must leave school grounds including, but not limited to, gyms, grass area in the north side, soccer field, and areas that remain in the north side of the car gates after being dismissed for the day. School will not provide any supervision of the students after the release.
2. Risk of Injury/Illness/Accident: School is not liable for any injury, illness or accident involving the students that may occur after the release whether such injury/illness/accident is the result of the students' actions, inactions or negligence, or the action, inaction, or negligence of others. Parent/Guardian is solely responsible for any injury/illness/accident involving the students that may occur after the release.
3. Release of Claims and Indemnification: Parent/Guardian hereby agrees to release, defend, indemnify and hold harmless the school, its officers, directors, employees, agents, servants, or representatives from any and all liabilities, claims, demands, actions, damages, loss, expenses and judgments including attorneys' fees, recovered or asserted against the school on account of injury, illness, accident, damage to property, involving the students after they depart from school grounds.
Parent/Guardian hereby acknowledges that they have carefully read these acknowledgements, know and understand its contents, that they agree to abide by each of the terms and conditions listed, and that they have signed it voluntarily and of their own free will. Parent/Guardian further understands that entering their full name below and submitting this form will be considered as a signature.
Please type in your full legal name.
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This form was created inside of Lotus School for Excellence.