Sibling Checkout Authorization & Waiver
Fill out this form for older siblings (Grade 5+) to check out younger siblings at the end of school.
Parent/Guardian Contact Information
Last Name:
First Name:
Parent/Guardian Name(s)
*
First Name
Last Name
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Authorized Sibling and Student Information
Authorized Older Sibling Name(s)
*
Authorized Older Sibling(s) Name and Grade:
*
Please list all older siblings that are authorized for check out. I.E. John (5th Grade)
Authorized Older Sibling Grade
*
#1 Younger Sibling to be Released
*
Grade:
*
Please Select
Junior Kinder
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
#2 Younger Sibling to be Released
Grade:
Please Select
Junior Kinder
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
#3 Younger Sibling to be Released
Grade:
Please Select
Junior Kinder
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
Authorization Agreement
I authorize the older sibling named above (Grade 5+) to check out the listed younger sibling(s) following Oaks Academy’s dismissal procedures.
Read the key rules & initial:
1. Sibling will sign out with Admin/Staff/Teacher/Teacher Aide and communicate any messages the staff has given back to the parent.
*
Initial Here
2. Release happens only at designated dismissal areas. No curbside/parking-lot handoffs by a sibling.
*
Initial Here
3. Older sibling must remain with the younger sibling until they are together off campus or transferred to a parent/authorized adult.
*
Initial Here
4. Older sibling may not transport non-listed students.
*
Initial Here
5. Notify the office immediately of any changes; this authorization remains in effect until revoked in writing. Oaks Academy may pause or revoke this privilege if safety concerns arise.
*
Initial Here
6. Parents/Guardians must be physically present on campus at the time of dismissal. Parents may remain in their vehicle for students to walk to them.
*
Initial Here
Authorization and Signature
I understand and accept that once my child(ren) are released to the authorized older sibling, Oaks Academy’s supervision ends. I agree to hold harmless and indemnify Oaks Academy, its staff, and volunteers from claims arising out of sibling-to-sibling release except in cases of gross negligence or willful misconduct.
Signature
Date
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: