2021-2022 Student Self-Dismissal Consent
Please read and fill out this form ONLY if your child has permission "self-dismiss."
Sign in to Google to save your progress. Learn more
If your child will not be picked up by a parent or other designated person at the end of the school day, complete below, giving your consent to have your child leave the school on his/her own to use public transportation, take a cab, walk to your home/office, etc.
Daystar Academy, its respective directors, officers, and employees are not liable for any actions taken by the student after having left the school (including traveling to a location against parents' will and/or tardiness in going home.)
Student Name *
Student's grade *
I hereby grant permission for my child to leave the Daystar Academy premises at DISMISSAL (2:45pm) on their own without parental supervision. *
He/She may leave school at dismissal in this manner (must choose one): *
Details about end of school dismissal...(which days, what time, any other info that would help us!)
I hereby grant permission for my child to leave the Daystar Academy premises after a sports practice on their own without parental supervision. Please give details below. *
Details about sports dismissal...(which sport, who can they leave with, etc.)
I understand that if my child is taking public transportation or leaving with another student or group of students, he/she is expected follow Covid safety protocol by wearing a mask, staying socially distant when possible, and washing/sanitizing hands often. This falls under the Daystar Community Covenant that was signed before school started. *
The undersigned hereby releases Daystar Academy, its respective directors, officers, and employees of and from any and all claims whatsoever arising or which may arise by reason of the child leaving Daystar Academy as outlined above and without direct adult supervision including such claims due to personal injuries or illness. I have read this waiver and agree to the terms thereby. My child has permissions as I have outlined in detail above. *
Parent e-signature *
Today's Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Daystar Academy. Report Abuse