PARENT/GUARDIAN PERMISSION FOR STUDENTS TO BE TRANSPORTED BY PERSONAL VEHICLE-Form
The following information must be provided to the Superintendent of Schools prior to approval being granted for students to be transported by personal vehicle:
1. Name of student being transported:__________________________________________.
2. Student’s Birthdate: ____/_____/______.
3. Student’s Address:________________________________________________________.
4. Parent/Guardian Name:____________________________________________________.
5. Parent/Guardian Emergency Phone Number:___________________________________.
6. Date of Travel: ____________________.
7. Destination: _____________________________________________________________.
8. Individual providing transportation:____________________________________________.
By signing this document, you are indicating that you are granting permission for your child to be transported in a personal vehicle on the date(s) indicated, and that you agree to the following:
I understand that participation in trip activities could involve risk of physical injury, illness, death or property loss, and despite safety precautions, the School District cannot guarantee safety thereof, as all risks cannot be prevented. The School District does not provide health and accident insurance for trip participants, and I understand that any medical expenses, property loss, or other personal expenditures that result during or from this travel/trip, are to be borne by the student/participant, or by their parent or guardian. I also hereby consent and give authorization to trip leaders to secure any emergency medical treatment in event I am unable to, and I agree to be responsible for the costs thereof. I further acknowledge that if I drive my own vehicle, or am a passenger in another’s private vehicle in connection with this trip/function, that the School District’s insurance does not cover such a private vehicle. I also understand that the School District cannot be responsible for assuring the safety and reliability of such private transportation or driver, nor for any non-sponsored activities and travel that I choose to participate in before, during or after the school sponsored function, and I therefore accept the risks and responsibilities associated with such private vehicle travel and activities.
In consideration of the opportunity afforded, with full knowledge and acceptance of the risks associated with this travel and the trip activities, and with full understanding of the above issues/conditions, I hereby release, indemnify and hold harmless the MSAD #60 School District , its faculty, staff, Board members, and agents from all form and manner of risks inherent in such travel, and from all claims and demands of any nature arising from participation in said trip.
______________________________________ _________________________
Parent/Guardian Signature Date