Student Walker Contract
Student Walker Contract
Please complete this form if your child would like to walk home from school.
Student 1 Name
Student 1 Name
*
First
Last
Add a second student?
*
Add a second student?
Yes
No
Student 2 Name
Student 2 Name
First
Last
Add a third student?
*
Add a third student?
Yes
No
Student 3 Name
Student 3 Name
*
First
Last
Add a fourth student?
*
Add a fourth student?
Yes
No
Student 4 Name
Student 4 Name
*
First
Last
Location/Address to which the student(s) will be walking:
Location/Address to which the student(s) will be walking:
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Approximate distance the student(s) will be walking is:
*
Walker Release Statement
*
I, the parent/guardian of the above named student(s), do hereby request that my child be classified and granted "walker status".
Parent/Guardian Name
Parent/Guardian Name
*
Title
First
Middle
Last
Suffix
Parent/Guardian Email
*
Draw your signature into the box below.
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.