Private Transportation/Activity Participation Release Form
During the course of the school year, your child may be involved in various activities sponsored by C.S. Lewis Academy, but held off campus. There will be many off-campus events to which the school will not be providing transportation. In the event that private transportation is necessary, C.S. Lewis Volunteer Drivers will transport student to and from the event. The intent of the the Private Transportation Release is confirm your choice whether or not your student may be a passenger in a privately operated vehicle.

This form is mandatory for all families to complete and must be completed yearly.

Name of Student
Your answer
Please choose ONE
If you have reservations or special stipulations, choosing box C will assign the responsibility of all transportation needs (when private transportation is being used) to the parent/guardian.
Transportation Options
Required
Participation Release
By my signature below I acknowledge that participation in school field trips and other school-related off-campus activities involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage.

In consideration for the opportunity to participate in these activities, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise.

If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

Medical Consent Provision

In the case of a medical emergency during participation in an activity or during transportation to or from such activity: In the event that I or other submitted emergency contact persons are unable to be reached, I authorize C.S. Lewis Academy personnel to consent to necessary medical treatment recommended by a medical professional.

Signatures
Participant and/or ALL parent/guardians if participant is a minor. In the case of guardians in multiple households, please submit a second form.
Student (Participant) Signature
I acknowledge that I have read and understand this policy. By typing your name in the signature box and clicking submit at the end of this document, you agree that you are electronically signing this agreement in accordance with the Electronic Signatures Act (Public Law No: 106-229), and agree to be bound by all terms and conditions. (type name)
Your answer
Parent/Guardian Signature
I acknowledge that I have read and understand this policy. By typing your name in the signature box and clicking submit at the end of this document, you agree that you are electronically signing this agreement in accordance with the Electronic Signatures Act (Public Law No: 106-229), and agree to be bound by all terms and conditions. (type name)
Your answer
Parent/Guardian Signature
I acknowledge that I have read and understand this policy. By typing your name in the signature box and clicking submit at the end of this document, you agree that you are electronically signing this agreement in accordance with the Electronic Signatures Act (Public Law No: 106-229), and agree to be bound by all terms and conditions. (type name)
Your answer
Submit
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