26-27 CV Athletics Travel Release Form

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Email *

Date of EVENT you are requesting release from: *

YYYY

Sport: *

Student Athlete First and Last Name *

Athlete Grade Level *

Parent First and Last Name: *

I certify that I am personally transporting the above named student, or have arranged for transportation with an adult (non student) of my choosing. *

Yes

If an adult other than myself is picking up my child, their name is listed below:

I understand that the CHARTIERS VALLEY ATHLETIC POLICY requires that athlete’s ride the bus/van to and from all athletic events and a departure from this requirement will release the CHARTIERS VALLEY SCHOOL DISTRICT from all liability for any adverse results that may occur. I agree to release the CHARTIERS VALLEY SCHOOL DISTRICT, its employees, and officers from all liability with reference to the above stated transportation.
*

I agree.

A copy of your responses will be emailed to the address you provided.

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