The undersigned, on behalf of themselves, their spouses (as the case may be), their representatives, heirs, successors and assigns hereby (1) authorizes the persons identified below to transport and remove the child/children identified above to and from the premises of Mountain Laurel Montessori School from time to time, and (2) agrees to indemnify and hold harmless Mountain Laurel Montessori School, its employees, agents, contractors and students, from and against any and all actions, causes of actions, costs, damages, claims, and liabilities of any nature whatsoever arising from or related to the transport and removal of the child/children identified above by the individuals identified below or which may otherwise occur while the child/children is/are in the care, custody, and control of the Individuals Identified below.
Effective: November 1, 2020, in the Commonwealth of Virginia
List two people to contact if parent(s)/guardian(s) cannot be reached.
Contacts may not be a parent/guardian listed above and must be located within a 30 mile radius of the school.