Permission To Travel printable pdf download

Return by August 1 to SMA

St. Mary’s Academy

PERMISSION TO TRAVEL

20162017

NOTE: SMA usually provides transportation to and from SMA events with 14 passenger minibuses. Our larger team

sports have more than 14 players on the roster and therefore transportation in addition to the minibus must be arranged

to and from away games.

I understand that my student ____________________________ (student's name) will be traveling from

SMA to off campus activities.

Please check all that apply:

______ My child has permission to travel in the SMA minibus or in a school sponsored bus.

______ My child has permission to travel with another parent/guardian.

______ My child has permission to travel with a student who drives.

______ My child has permission to travel on the city bus.

______ My child has permission to travel on all other public forms of transportation

(Uber, taxi, Lyft, etc.)

______My child has my permission to drive herself. ( for high school only)

______ My child has permission to drive herself and other teammates. ( for high school only)

Any changes to the above plan will be sent by the parent/guardian to the school in writing. PLEASE NOTE THAT THE SCHOOL

WILL NOT MONITOR COMPLIANCE WITH THE ABOVE UNDERSTANDING.

I hereby give my consent for emergency medical, surgical, or dental treatment in the event of accident, injury, sinckness, or

other event of an emergency nature which would require immediate treatment. I understand that St. Mary’s Academy will notify

me as soon as possible of any actions taken with regard to such treatment as soon as circumstances permit.

Should my child’s behavior become unacceptable or jeopardize the safety and health of others, I will be responsible for

retrieving my child from the activity.

__________________________________________

_______________

PARENT SIGNATURE

DATE

I will travel only under the conditions my parents/guardians have indicated above.

__________________________________________

_____________

STUDENT SIGNATURE

DATE

If at any time you have concerns regarding vehicle, driver safety or behavior of our students on the minibus, please

contactPatty Disney 3037628300 (x242) immediately.

4545 S. University Blvd Englewood, CO 80113 FAX (303) 783‐6201 PHONE (303) 762‐8300

EMAIL: smathle cs@smanet.org (High School) dsiennicki@smanet.org (Middle School) jneal@smanet.org (Lower School)

Permission To Travel