Student Name: (print) ______________________________________________________________

Note two signatures are required below; Parent/Guardian and Faculty Advisor.

This form is to be returned by  February 27, 2008 to any of the following teachers: Mr. Andrews, Dr. Itzko, Mrs. Ricks or Mr. McCormick.  For each school day this form is late, one (1) point will be deducted from the student's final grade.

Received:     February 27, 2008___________     If late, date received___________________

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Authorization / Release for Participation

The undersigned being the parent or guardian of above student hereby authorizes student to attend and participate in the Marple Newtown High School Senior Project for the current school year.

It is hereby understood and agreed that transportation for student to and from the location of the Senior Project site is the responsibility of the student and the parent (s) or guardian (s).  The undersigned acknowledges that there is insurance coverage provided by student, parent, or guardian for student while traveling to and from the location of the Senior Project site and the amount of this coverage is satisfactory to the undersigned.

In consideration of the training and experience which student will receive through this program, the undersigned agrees to release and to indemnify, defend and hold harmless, including reasonable attorneys’ fees, the Marple Newtown School District and its employees and representatives and the employer or field experience sponsor and their employees, agents and representatives from any claims or liability of any kind arising out of this program including, without limitation, injuries to student, or third parties, as a result of action or inaction of student.

Intending to be legally bound hereby, the undersigned executes this Authorization and Release on the date indicated below.

Parent or Guardian signature: ______________________________________ Date: _____________

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Faculty Advisor Selection

My Faculty Advisor will be (print) ________________________________________________________

(Print)

Faculty Advisor signature: _______________________________________________ Date: _____________

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