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Parent Permission To Leave School Premises
Student Last Name, First Name
Teacher, Grade
Parent/Guardian Last Name, First Name
Phone
--
I give permission for my student to leave school premises under the following circumstances:*
My child must sign out to leave school premises.*
Yes No
Emergency Contact
Name
Relationship
Phone Number
By signing, I assume all risks for the above permissions and will take full responsibility for my child once he/she leaves school property. I discharge the school, any individual employed by the school, and/or the district from any liability arising from my child being off school property.
Print Parent/Guardian Name*
Signature of Parent/Guardian*
Date

Name	Relationship	Phone Number

Parent Permission To Leave School Premises