Parish Link Waiver Form

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Please complete the informational questions below before progressing to the next sections. All sections must be completed before submitting.

Section 1 - Student and Parent/Guardian Information

Section 2 - Acknowledgment of On-Campus School Hours Service Restrictions

Section 3 - Release of Liability / Hold Harmless Waiver

Student Name *

Please provide First and Last name

Student's Grade *

Parent/Guardian Name *

Please type the First and Last name of the parent/guardian primarily responsible for communication regarding this agreement and any future communication regarding services provided by the below named Parish Link Provider.

Parent/Guardian Email *

Please be sure to review your input. This email address will be used for confirmation and future communication. It is critical that you type your email correctly for the form to successfully submit.

Parish Link Provider Name *

Parish Link Provider Email *

Please check for accuracy, this will be used to notify the provider that they are permitted to begin working with your student. It is critical that you type their email correctly for the form to successfully submit.

Subject/Content Area *

Core Academic - Foreign Language

Core Academic - History

Core Academic - Language Arts

Core Academic - Math

Core Academic - Multisubject

Core Academic - Science

Functional Academic - Handwriting

Functional Academic - Homework Help

Therapeutic - Dyslexia Therapy

Therapeutic - Speech Therapy

Therapeutic - Occupational Therapy

Therapeutic - Counseling

Therapeutic - Executive Functioning

Other:

Content Area Teacher *

If the service being provided is content area specific (e.g. Math Tutor, Calculus Tutor, Chemistry Tutor, etc.), please indicate your student's content area teacher so they can be made aware.

Note: If it is not (i.e. speech therapy, counseling, etc.) select "Not Listed" at the very bottom of the list.

Advisor / Homeroom Teacher *

Please select your student's home room teacher (LS) or Advisor (MS & US).

Student's Study Hall Teacher (if applicable)

For MS and US students with a Study Hall or participating in Parish Lab please select the teacher.

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