Form from: Holy Family Academy

2025-2026 HFA Annual Student Dismissal Form

Please indicate the method each of your children will be getting home each day. If your child is to go home via a different method on any given day, you must contact the office before 2:00 PM. Indicate "After School Care (ASC)" for those staying past 3:15pm. Pre-K students must have an adult pick them up to be marked as a walker. Walkers must live within one mile of Holy Family Academy.

Family Name

Please list your students' names and grades

Dismissal Method

Any additional dismissal notes (if more than one dismissal method indicate days of the week for each):

Will your child(ren) be participating in a carpool?

Please describe carpool arrangements:

Will your child (either regularly or occasionally) be picked up by someone other than a parent?

Please list the adults who are authorized to pick up your children, including their first and last names, relationship to child and phone number. Limit to three.

Carpool Authorization

Holy Family Church and Holy Family Academy do not participate in the formation of any carpools for the transportation of students to or from school. No background check or insurance verification have been made on any drivers as these arrangements have all been made by the families involved in the carpools. This form is only used to verify which child are allowed into which car. Holy Family Church and Holy Family Academy assume no responsibility or liability for any claim related to carpools to and from school. By signing this form I agree to release, hold harmless and indemnify Holy Family Church and Holy Family Academy for any claim related to carpools to and from school.

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Walker Policy Acknowledgement

By signing below, I certify that I live within a one mile radius of Holy Family Academy and that my children are eligible to be walkers. A "walker" is not a substitute for car line dismissal. Students will not be allowed to linger in parking lots, school or church areas, and are not permitted to wait for rides in the church or other church areas. I relinquish all responsibility from Holy Family Academy and its staff by giving my children permission to walk directly home from school.  I understand that by signing this form, I am solely and legally responsible for my children at the time of dismissal. I will not hold Holy Family Academy or its staff accountable for any illness, injury, cost of medical treatment or any event that may arise in connection with my children and my chosen dismissal procedure.

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