ASSUMPTION OF RISK AND WAIVER OF LIABILITY

I am the parent of _________________________________ (my child), a student enrolled at

Independent School District No. 623, Roseville Area Schools (District). I have asked the
District to excuse my child from supervised activities at school during the school day so that my
child can fulfill the requirements of his or her sincerely held religious beliefs by engaging in
prayer during the school day.
I understand the following:
The District is not sponsoring, endorsing, encouraging, discouraging, or impairing
my childs participation in prayer or any related activities.
The District is not responsible for supervising my child during any period of time
he or she is excused to pray.
The District will not assign an employee, agent, or volunteer to supervise my
child during any period of time he or she is excused to pray, regardless of whether my
child remains on school property or leaves school property.
My child may be indirectly supervised or completely unsupervised during any
period of time he or she is excused to pray.
The District is not obligated to monitor my childs actions or whereabouts during
any period of time he or she is excused to pray.
Leaving school property and being present on school property without adult
supervision both present inherent risks to my child, including, but not limited to, harm to
personal property, emotional abuse, physical abuse, sexual abuse, other bodily injury, and
death.
Knowing and appreciating the risks involved, I voluntarily assume all risks associated with the
District granting my request to excuse my child from supervised activities at school so he or she
can pray during the school day. Additionally, I voluntarily waive, release, and forever discharge
the District and its current and former board members, officers, directors, employees, agents,
insurers, and representatives from any and all liability, actions, claims, and demands for personal
injury, death, or property loss arising out of or relating to my childs participation in
unsupervised prayer on or off school property. Finally, I waive any right to bring any claim,
demand, legal action, or cause of action against the District, its board members, officers,
directors, employees, agents, insurers, or representatives, unless they engage in willful and
wanton misconduct that directly causes harm to my child.
I HAVE READ THIS DOCUMENT CAREFULLY AND UNDERSTAND THAT IT IS
LEGALLY BINDING.
Dated: __________________

_________________________________
Signature of Parent/Guardian

Dated: __________________

_________________________________
Signature of Parent/Guardian

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