Notice Of Intent To Home School Template (Page 4 of 4) in pdf

Notice Of Intent To Home School Template Page 4

Part B

Notice of Intent to Home School and Waiver forms must be filed every year

by the established deadlines.

HOME SCHOOL WAIVER FORM

(Do not modify/revise form)

Arkansas Code Annotated § 6-15-503, requires that parents and guardians who wish to

home school their children, sign a waiver acknowledging that the State of Arkansas is not

liable for the education of their children during the time the parent or guardian chooses to

home school.

By my signature below, I hereby certify and agree as follows:

1) I am the parent or legal guardian of the child(ren) listed below.

2) I have fully read and understand the terms of this waiver.

3) As of the date I sign this waiver, I hereby acknowledge that the State of Arkansas

is not liable for the education of the child(ren) listed below during the time I

choose to home school the child(ren).

Please print clearly and legible. Give student’s Legal Name.

STUDENTS FIRST, MIDDLE, AND LAST NAME

DATE OF BIRTH

Signature of Parent/Guardian

Date

Address

Phone (area code & number)

City, State, Zip

(Revised May 2014)

Notice Of Intent To Home School Template Page 4