Jordan School District

A Full Spectrum of Educational Opportunities

Employee Involvement in Private, But Public

Education-Related Activities

POLICY AA444 PARENT NOTIFICATION AND RELEASE OF LIABILITY

I, the undersigned, understand that the public school employee listed below will
perform the duties associated with participation in a private, but public education-related
activity separately and apart from his/her employment with Jordan School District as per
Jordan School District Policy AA444, Employee Involvement in Private, but Public
Education-Related Activities. Furthermore, the performance of these duties will not inter-
fere with the performance of employment duties with the school district in any way.

I do not hold Jordan School District liable for actions of this employee while pro-
viding the stated activity as listed below.

Employee Name: ____________________________________________

Student’s Name: ____________________________________________

Activity(ies): ____________________________________________

Parent/Guardian Signature: ____________________________________________

Date: ____________________________________________

Distribution of copies: White–Principal • Yellow–Employee • Pink–Parent/Guardian Form B 04/23/01 A-0988