Rise & Shine Freedom School
Waiver of Responsibility

This form is to be observed and completed ONLY if the attending Scholar will be walking/biking/driving to Rise & Shine without the supervision of a parent/guardian. 

I, __________________________________________ (Parent/Guardian’s Name), give permission to my child/children to walk/bike/drive to and from Rise & Shine Program daily.  I understand that I am responsible for assuming any and all liability for this decision and my child’s actions while en-route before and after the program. 

I do hereby release, hold harmless, and forever discharge Neighbors In Ministry (NIM) Rise & Shine Freedom School its affiliates, agents, staff, licensees and assigns from any and all actions, claims, damages, and medical expenses which may occur during this activity.

Print Name: __________________________________________________________________________________________

Signature: _______________________________________________                    Date: ___________________________

Please list all of your children who will be walking from Rise & Shine School 

Name:___________________________________________________

Name:___________________________________________________

Name:___________________________________________________

Name:___________________________________________________