Student Name(s):

Parent/Legal Guardian Name(s):

I authorize the Student to participate in classes and activities for the duration of the 2026-2027 school year. I understand classes may be held virtually when necessary. (Initial):

I authorize the following people to pick up the Student (list names & initial):

I authorize first aid, 911 calls, emergency medical treatment, and emergency transportation for the Student if deemed necessary by Koinonia Homeschool Hybrid Academy. (Initial):

I authorize the Student to participate in the classes and activities of Koinonia Homeschool Hybrid Academy, including off-site travel, with the full knowledge of the risks of bodily injury, illness, death, or damage to personal property, and I voluntarily assume all such risks. (Initial):

I recognize that the benefits and value of the Student’s participation in the Christ-Centered Learning classes and activities provided by Koinonia Homeschool Hybrid Academy exceed the tuition and fees charged and paid. (Initial):

In exchange for and in consideration of allowing the Student to participate in the Koinonia Homeschool Hybrid Academy, I agree for myself, my co-parent or co-guardian, the Student, the Student’s representatives, executors, administrators, agents and assigns to release, indemnify and hold harmless, Koinonia Homeschool Hybrid Academy, and its members, staff, and agents, from any and all liability, actions, causes of action, damages, claims, or demands of any kind and nature whatsoever, including, but not limited to, claims for negligence, recklessness or any other form of action for which a release may be legally given (including attorneys’ fees and costs), which may arise from or in connection with the Student’s participation in classes and activities. Notwithstanding the foregoing, I do not waive or release any claims for intentional misconduct or criminal actions. (Initial): 

I confirm that I have read and agree with Koinonia’s Statement of Faith and understand that participation is contingent upon this agreement.

Off-Campus Activity Liability Waiver

I, the undersigned parent or legal guardian, give permission for my child(ren) to be taken off the Koinonia Homeschool Hybrid Academy property to the public park directly behind the church facility. I understand and acknowledge that students will only be taken to the park when no other individuals are present at the park facility. I understand that reasonable supervision will be provided during this off-campus activity. I acknowledge that participation in outdoor and off-campus activities may involve risks, including but not limited to personal injury, illness, or accidents. By signing this form, I voluntarily assume all risks associated with my child(ren)’s participation. I hereby release, waive, discharge, and hold harmless Koinonia Homeschool Hybrid Academy, its staff, volunteers, officers, and affiliates from any and all liability, claims, demands, or causes of action arising from injury, loss, or damage sustained by my child(ren) while participating in this off-campus activity.

Photo Release

I give consent to Koinonia Homeschool Hybrid Academy to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of myself or the Student in any public media, including but not limited to internet, social media and/or print without payment or other consideration.

I hereby certify that I am voluntarily signing this Authorization, Waiver and Release of Liability, and intend to be legally bound by the terms of this document. I have read all of its provisions, and fully understand its significance.

Parent/Legal Guardian Signature: