TEANECK PUBLIC SCHOOLS
OPEN LUNCH PERIOD
PERMISSION SLIP AND INDEMNIFICATION AGREEMENT
I,
, am the parent or legal guardian of
(Print name of Parent or Legal Guardian)
hereinafter referred to as
(Print Name of Pupil)
(“my child”) who is currently an 11th or 12th grade student enrolled in Teaneck High School.
I hereby authorize the Teaneck Board of Education and its appropriate administrators to allow
my child to leave the building and grounds of his/her school during his/her assigned lunch period
every day during the
school year. I am aware that my child will be
subject to appropriate consequences.
I understand that I am responsible for my child and his/her actions when he/she leave the
school building and/or school grounds. I understand and accept that neither the Teaneck
Board of Education nor its members, agents, servants or employees will in any way monitor
and/or control my child’s whereabouts or safety, or be responsible for my child’s acts or
omissions, while my child is away from his/her school building and school grounds. In support
of this authorization, I provide the indemnification agreement set forth below.
Indemnification Agreement:
I hereby agree to defend, indemnify and hold harmless the Teaneck Board of Education
and/or its members, agents, servants or employees or other representatives from any and all
liabilities, claims, physical injury, bodily injury, damages, losses and expenses, including
reasonable attorneys’ fees, that may arise out of and/or in connection with my child’s
departure from his/her school building and/or school grounds in connection with my child’s open
lunch period. This indemnification agreement’s scope of coverage shall include, but not be
limited to, bodily injuries suffered by my child, other students, Board employees and/or any
other persons.
Parent/Guardian’s signature
Date
St