Release and Permission for Students to Walk or Ride a Bike - Middle School

In order to ensure your child’s safety, we are requesting that you complete this form to grant permission for your child to walk or bike to and from school. Please note that this option is available only for Middle School students and fourth grade students when accompanied by someone in Middle School. 
 

Required

Parent Namerequired
First Name
Last Name

 
I hereby give permission for my child(ren): 
Student 1 Namerequired
First Name
Last Name
Student 1 Grade:required
4th Grade - Teacher:Student 1
Student 1
5th Grade - Advisor:Student 1
Student 1
6th Grade - Advisor:Student 1
Student 1
7th Grade - Advisor:Student 1
Student 1
8th Grade - Advisor:Student 1
Student 1
to walk/bike home from the school premises. In consideration of allowing my child to leave campus, I/We knowingly and voluntarily release, indemnify and hold harmless GSES from any and all claims, damages, demands, or actions arising from, relating to or growing out of, directly or indirectly, my child leaving campus on foot or by bike, including claims of negligence by or strict liability of GSES. I understand walking or biking off campus involves serious health risks and a danger of accidents, including the possibility of death. Knowing this, as parent/guardian, I assume all risks. I have read the information in full, and to the best of my ability understand the information above. I warrant by my signature my authority to sign this release and that I am authorized person(s) to make decisions for my child. I agree to indemnify and defend Good Shepherd against claims I am not authorized to execute this document.
Student 2 Namerequired
First Name
Last Name
Student 2 Grade:required
4th Grade - Teacher:Student 2
Student 2
5th Grade - Advisor:Student 2
Student 2
6th Grade - Advisor:Student 2
Student 2
7th Grade - Advisor:Student 2
Student 2
8th Grade - Advisor:Student 2
Student 2
to walk/bike home from the school premises. In consideration of allowing my child to leave campus, I/We knowingly and voluntarily release, indemnify and hold harmless GSES from any and all claims, damages, demands, or actions arising from, relating to or growing out of, directly or indirectly, my child leaving campus on foot or by bike, including claims of negligence by or strict liability of GSES. I understand walking or biking off campus involves serious health risks and a danger of accidents, including the possibility of death. Knowing this, as parent/guardian, I assume all risks. I have read the information in full, and to the best of my ability understand the information above. I warrant by my signature my authority to sign this release and that I am authorized person(s) to make decisions for my child. I agree to indemnify and defend Good Shepherd against claims I am not authorized to execute this document.
Student 3 Namerequired
First Name
Last Name
Student 3 Grade:required
4th Grade - Teacher:Student 3
Student 3
5th Grade - Advisor:Student 3
Student 3
6th Grade - Advisor:Student 3
Student 3
7th Grade - Advisor:Student 3
Student 3
8th Grade - Advisor:Student 3
Student 3
to walk/bike home from the school premises. In consideration of allowing my child to leave campus, I/We knowingly and voluntarily release, indemnify and hold harmless GSES from any and all claims, damages, demands, or actions arising from, relating to or growing out of, directly or indirectly, my child leaving campus on foot or by bike, including claims of negligence by or strict liability of GSES. I understand walking or biking off campus involves serious health risks and a danger of accidents, including the possibility of death. Knowing this, as parent/guardian, I assume all risks. I have read the information in full, and to the best of my ability understand the information above. I warrant by my signature my authority to sign this release and that I am authorized person(s) to make decisions for my child. I agree to indemnify and defend Good Shepherd against claims I am not authorized to execute this document.

 
I HAVE READ AND UNDERSTAND THIS RELEASE AGREEMENT. required
By checking this box, you are agreeing that your typed name (electronic signature) is the legal equivalent of your manual signature.required

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