Ajo High School

Fill in this form and click the "Go to Printable Page" button to create a printable Waiver of Responsibility form that requires only your signature. If you leave a form field blank, then the printable page will provide a blank line to be filled in by hand. If you select item 4, the printable Waiver of Responsibility will provide blank lines that may be filled in by hand.

Date:

Parent -Guardian Name:

Student Name:

Event:

Date of Event:

Location of Event:

Select one of the following and provide details for that selection:

1. Release my child to ME after the school sponsored event.
   • Transportation will be provided by:
2. Release my child to another specified person after the school sponsored event.
   • Release my child to:
   • Transportation will be provided by:
3. Drop off my child at a specified location near our home.
   • Location:
4. Print the form with blank lines to be completed by hand.