Release from Care and Student Transportation Permission Form

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I hereby grant my permission for my child to be released from the care and supervision of the Sacred Heart Preschool or Sacred Heart Model School to the care of the Sacred Heart School district for the purpose of attending the class listed below at the Sacred Heart School for the Arts.

Upon release of my child from the care and supervision of the Sacred Heart Preschool or Model School, I further grant my permission to be transported by bus to the classes listed below at the Sacred Heart School for the Arts to be returned and readmitted to the Sacred Heart Preschool or Model School upon conclusion of the class listed below.

In consideration of the making of the arrangements for transportation, I hereby release and save harmless Sacred Heart Schools and the Sacred Heart School for the Arts, Louisville, Kentucky, and any and all personnel of the School for the Arts from any and all liability for any injuries, loss, or damage to equipment/instruments, or other claims arising out of or resulting from this transportation or from participating in the class listed below at the Sacred heart School for the Arts.

Parent's or Guardian's Name*

Answer required for "Parent's or Guardian's Name"

Child's Name To Be Transported*

Answer required for "Child's Name To Be Transported"

During class time, parents/guardians may be reached at this phone number:

Number Required

SHSA Class

Answer required for "SHSA Class"

Day of the Week To Be Transported (You may select more than one day)*

Answer required for "Day of the Week To Be Transported (You may select more than one day)"

Monday

Tuesday

Wednesday

Thursday

Friday

Time of Transport*

Answer required for "Time of Transport"

Semester

Answer required for "Semester"

Fall '22

Spring '23

School To Be Picked Up From

Answer required for "School To Be Picked Up From"

SHP

SHMS

Roundtrip Service?

Answer required for "Roundtrip Service?"

Yes

Parent's Signature (Please Print Full Name)*

* By printing your full name on the line below you are providing a digital signature in lieu of a written signature

Answer required for "Parent's Signature (Please Print Full Name)"

Date Signed*

Answer required for "Date Signed"

Please fix the highlighted areas below before submitting.

Release from Care and Student Transportation Permission Form