Boone High School PSAT/SAT October 12, 2022 Early Release Permission Form
Student Name: ______________________________
Student ID Number: __________________________
Directions: This Indemnification and Release of Claims shall be signed by the parent/legal guardian at the school (or, in the event a
parent/legal guardian cannot come to the school, shall be notarized and sent into the school – see page 2) and shall be considered the
written request for early release under School Board Policy – Student Dismissal Precautions, which provides: “No student shall be
permitted to leave the school grounds during the school day without the principal’s or designee’s prior approval based upon a written
request from the student’s parent or legal guardian.” A new request must be filed with the school for each exam.
Please identify the method that your student will be leaving campus on October 12, 2022: ___________________________________
_______ (initials) Please consider this Indemnification and Release of Claims as my written request for my child to be permitted to
leave the school grounds during the day(s) and time(s) specified below for the following reason(s):
_______ (initials) I acknowledge that such early release from my child is not sponsored by, at the request of, or sanctioned by, the
Orange County School Board and I acknowledge that this early release from school is not part of any OCPS curricular or
non-curricular activity.
_______ (initials) I, on behalf of my child, agree to indemnify and hold harmless OCPS from any and all claims, demands, losses,
causes of action, damages, lawsuits, judgments, including attorneys' fees and costs, arising out of or relating to the early release of my
child.
_______ (initials) I, on behalf of my child, agree, at my own expense, to provide attorneys to defend against any actions brought or
filed against OCPS, its board members, officers, agents, and employees with respect to the subject of indemnity contained herein,
whether such claims or actions are rightfully brought or filed, regarding the early release of my child.
_______ (initials) I shall be solely financially responsible for paying such defense attorney’s fees and costs and any monetary
judgment arising out of such lawsuit.
_______ (initials) BY SIGNING THIS FORM, I AM GIVING UP MY CHILD'S RIGHT AND MY RIGHT TO RECOVER FROM
THE ORANGE COUNTY SCHOOL BOARD, AND ITS BOARD MEMBERS, EMPLOYEES, OR AGENTS, IN A LAWSUIT
FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO MY CHILD OR ANY PROPERTY DAMAGE THAT RESULTS
FROM THE EARLY RELEASE OF MY CHILD.
_______ (initials) I understand that if I do not sign this Indemnification and Release of Claims, OCSB will prohibit my child from
being released early.
_______ (initials) I have read the content of this Indemnification and Release of Claims, understand it, and agree to its content in its
entirety.
________________________________________________
________________________________________________
Parent/Legal Guardian Printed Name
Parent/Legal Guardian Signature
For Office Use Only: Received by: ________________________________________ Date: _____________________
To be maintained in student’s cumulative record.
NOTARIZED STATEMENT:
In the event a parent/legal guardian cannot come to the school, the first page of this Indemnification and
Release of Claims shall be initialed and signed, and the notary block shall be completed below. The
parent/legal guardian shall then provide the original to the school.
State of Florida
County of ____________________
The foregoing instrument was acknowledged before me this ______ day of 20____, by (name of person
acknowledging) __________________________________.
(Seal) Signature of Notary Public Print, Type/Stamp Name of Notary
Personally known:_________
OR Produced Identification:__________
Type of Identification Produced:________________________
____________________________
For Office Use Only: Received by: ________________________________________ Date: _____________________
To be maintained in student’s cumulative record.