Transportation Department

 Parent or Guardian Consent Form

I hereby give my permission for my child ___________________________________

To travel by ( circle one) Bus, Daycare Van, Car rider, walker, bike rider,  rather than his/her regular mode of transportation FROM Cary Woods Elementary to _______________________( name of destination). Permission for this change in travel is granted from __________ through _________________.

_______________________________________            ________________________

Parent/ Guardian Signature (required)                  Parent/ Guardian daytime phone

In  granting permission, I hereby expressly waive claim for liability against Auburn City Schools, the Board of Education, including its employees and representatives and release them from liability in connection with this trip. Further, I assume full responsibility for any damage to persons and/or property caused by my child. I further expressly agree that in the event disciplinary action may be necessary, my child may be returned home at my expense.

Further, in case of emergency or injury to my child, I hereby authorize the school to act in the best interest of my child. I further consent and will be responsible for any medical and/or dental treatment that may be advisable at the discretion of any physician or dentist. I understand that I will be personally notified if it becomes necessary for my child to be returned home and/or require health treatment.

It is further warranted that if this TRIP PERMISSION FORM is signed by one of two parent/ guardians, it is also the authority of the other.

*THIS FORM IS TO BE USED FOR ALL CHANGES IN TRANSPORTATION. PERMISSION WILL NOT BE GRANTED BY ANY OTHER MEANS THAN A SIGNATURE ON THIS FORM.

___________________          ____________

Administrator initials         Date

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