A liability form must be completed or on file at Southern Lakes Consortium Alternative High School in order to participate in any program/event offered.
Student Waiver Form
Child’s Name_________________________________ Birth Date__________________________
Address___________________________________ School SLCAHS_____________________
Home Phone___________________________ Work Phone_________________________
Insurance Company Name_______________________________
I as parent/guardian of the above named child, assume all risks and hazards incidental to my child’s participation in any Community Education Department programs/events, including transportation to and from all programs/events. I hereby waive, release, absolve, indemnify and agree to hold harmless the Community Education Department, Burlington Area School District, their officials, supervisors, participating districts, and participants to any claim and damages as a result of my child’s participation. I understand that this waiver is valid anytime my child participates in any Community Education Department sponsored program/even until he or she reaches the age of eighteen (18). I understand that students under the age of 18 are prohibited from riding to and from Field Trips/Community Service/School with anyone other than parent/guardian.
Parent/Guardian Signature__________________________________________ Date_________________