Permission to Leave Campus Form                     2023-2024
This form gives permission for a student to leave campus in a car with someone other than their parent.  Complete a form for each student who has this permission.  This form does not give permission to walk off campus.


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Email *
Parent First Name *
Parent Last Name *
Student First Name *
Student Last Name *
Parent Phone Number *
Campus (check all campuses your student attends) *
Required
If a parent is not picking up a child, you must answer this question.  Check all that apply.
If only certain individuals can pick up my child, please list them here.
**If I have given permission above for my student(s) to leave campus, I hereby release ODA from any and all supervision responsibility and I agree to release, indemnify and hold harmless ODA for any accidents or occurrences which may happen involving my student once he/she has signed out and left the building either temporarily or at the end of his/her classes for the day. I agree that it is my responsibility to update this release if necessary and bring it to every campus my student attends. *
Required
Parent Signature: By typing your FULL name, you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document. By typing your name using any device, means, or action, you consent to the legally binding terms and conditions of this document. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and One Day Academy. You are also confirming that you are the parent authorized to sign this document. The data will be time-stamped when signed. *
If there are any special circumstances of which you believe we need to be aware, please list here:
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