Single Trip Parental Consent Form And Waiver Of Liability

ADVERTISEMENT

SINGLE TRIP PARENTAL CONSENT FORM AND WAIVER OF LIABILITY
This form is to be filled out and submitted 24 hours prior to any trip where a student’s parent(s) or
guardian would like the student to be allowed to utilize private, non-parental transportation to return
home from a school sponsored extra-curricular activity.
SCHOOL DISTRICT POLICY
School District 509-0J attempts to provide transportation to and from all officially sanctioned extra-
curricular activities. Our policy prohibits use of non-parent private vehicles for the students’ return
home, except where the parent/guardian has specifically given consent. If you wish your student to be
allowed to utilize non-parental private transportation, you must sign and return this form to your
child’s coach or other supervisor of the extra-curricular activity. Te supervisor of the activity has the
authority to deny the permission if he or she feels that the alternative transportation may put the
student at risk. If this form is not signed and returned, the District will follow its regular school policies
with respect to your student.
CONSENT
The undersigned parent/guardian of (
) _____________________________________
name of student
Requests and consents to allow said students to be allowed to travel with following adult person for
transportation home from the following extra-curricular activity:
DATE OF ACTIUVITY: The _____________ day of __________________, 20________
(date)
(month)
(year)
TYPE OF ACTIVITY:
______________________________________________________________
NAME OF PARENTALLY-AUTHORIZED DRIVER: _______________________________________
(must be an adult)
WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
If my student utilizes the above private transportation, I hereby agree to hold harmless, defend and
indemnify school district 509-J, its employees and any of its representatives from all damages of any nature,
whether property damage, physical injury or death, which may occur to or be caused by my student while
utilizing said private transportation.
______________________________________________________
____________________
(Signature of parent or guardian required)
(Date)
______________________________________________________
(Daytime phone of parent or guardian)
* * * * * * *
* * * * * *
All sections above must be completed before submitting to the school for approval *
_________________________________________________________________
________________________
(Athletic Director Signature)
(Date received)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go