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WAVIER AND RELEASE FOR PARENTS OF WALKING STUDENTS

The Board of Directors of Falls Lake Academy, while understanding it is the parent’s right and prerogative to allow
their individual children to walk to and from Falls Lake Academy, strongly discourages this practice for the safety
of our students and their families. However, if a particular family still wants their child or children to walk to or
from school, the Board of Directors of Falls Lake Academy, along with the Principal and Staff, require each family
to follow the guidelines listed below and sign this waiver and release.

Guidelines:
-Students must live within a one mile radius of the school in order to walk home.
-Students in grades 4 and up may walk home.
-Students in grades K-2 may not walk home unless accompanied by a sibling in grades 4 and up.
-Students must utilize sidewalks where available and follow traffic guidelines from the NCDOT.

Student ID:

Student Name:

Student Grade:

Waiver and Release

I,

parent/guardian of the above-listed student

agree to waive all responsibility of Falls Lake Academy, the Principal, and all staff, with respect to the safety and well- being of my child when walking to or from school. The school will be responsible only to see that my child reaches the predetermined and designated space and release point for those students allowed to walk to or from school. Once my child has reached this designated area, I understand that I further release the school and its Board of Directors, Principal, and all staff from all responsibility to my child with regard to his or her safety and well-being.

Hold harmless

I,

parent/guardian of the above-listed student

also agree to hold Falls Lake Academy, the Principal, and all staff harmless as to any injury to my child once he/she is released from designated area, as well as hold the same harmless as to any activities, legal or otherwise, that have therefore become the responsibility of my child or me as parent of the individual child.

Indemnification

I,

parent/guardian of the above-listed student

also agree to Indemnify Falls Lake Academy and the Principal and staff of nay and all litigation that results from my parental request for my child to walk to or from school.

I have read and understood all that is contained above, and while I understand the Board of Directors’ and
Principal’s and staff’s objection to children walking to or from school, I still, based on my wish to allow my child to
walk to or from school, agree to waive, release, and hold harmless Falls Lake Academy, the Principal and staff, and
also agree that I will indemnify the same from all litigation that results from my parental wish to allow my child to
walk to or from school.

(Signature)

(Date)

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