Transportation Waiver For Extracurricular Activities Form - Greenup County School District


09.36 AP.212
Transportation Waiver For Extracurricular Activities
Use this waiver if you are requesting that your child will not be taking the school
transportation provided to or from a scheduled / sanctioned event of
(Individual School Name)
I am requesting that ___________________________ ride with __________________________
(Student’s Name)
(Transporting Adult’s Name)
to ___________________________ on _______________ at ___________________________.
(Name of Activity)
(Location of Event)
I swear and affirm that the Greenup County School District officials are in no way endorsing,
authorizing, nor approving this alternative mode of transportation to this school sponsored event.
I therefore agree to release the Greenup County Board of Education officials and school officials
from liability with reference to the above alternative transportation.
I accept full responsibility for my child’s well being during such transportation service, but I
understand that my child will remain obligated to abide by all directions of the supervising
authority of this school sponsored activity and any misconduct may subject my child to
disciplinary action the same as if he/she had used the school transportation provided.
___________________________ ________
___________________________ ________
Parent/Guardian’s Signature
Transporting Adult’s Signature
Form Must Be Notarized
State of Kentucky
County of Greenup
The foregoing instrument was acknowledged before me this __________ (date) by
___________________________(name of person acknowledged).
Notary Public: _____________________________
Title (and Rank): ___________________________
Print Name: _______________________________
My Commission Expires: _____________________
09.223, 09.3
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