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Floyd County, Georgia Office of the Sheriff TURNING POINT RELEASE AND PERMISSION FORM
Student Name: ____________________________________ Address: __________________________________________________________________________________ City: ___________________ _________________ State: _________________ Zip Code: ________________ Age: _________ Date of Birth: ____________________ Gender: _______M _______F School or Group: ______________________________________________ Grade: _____________________ Name of Parent/Guardian: ___________________________________________________________________ Contact Information: (Home Phone) ______________________ Cell Phone: __________________________ Reason why you are requesting the program: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
WAIVER/DISCLOSURE
I ________________________________ parent/guardian of_____________________________________ (student) am requesting that my child enter and complete the Turning Point Program at the Floyd County Jail. I understand that the program involves a reality base to incarceration and that my child may have frank discussions with selected inmates. In consideration for allowing my child to participate in the program, the undersigned custodial parent or guardian covenants not to sue and agrees to release, discharge, hold harmless, and indemnify the Floyd County Sheriff’s Office, Floyd County, their agents and employees, and the Floyd County Board of commissioners of all liability, claims, damages, or injury to persons and property including costs and attorneys’ fees arising out of or in any way associated with my child/ward’s participation, attendance, travel to and from or other involvement in the program, including but not limited to, all acts or omissions, or omissions constituting negligence except for willful wanton or gross negligence or misconduct.
I agree that this document and in particular, the release, waiver, and indemnity provisions, shall be construed under the laws of the State of Georgia, and if any portion is held invalid or unenforceable, the remainder shall remain and continue in full force and effect.
I hereby accept this agreement and consent and agree to the above terms and conditions.
Date:________________________ Custodial Parent/Legal Guardian: ________________________________________
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