Alternate Athletic Transportation Waiver

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Please complete this form for every instance a student athlete is being transported in a manner different from school transportation. You can submit this form multiple times.

Email *

Name of the person completing the Alternative Transportation Form: *

The parent completing this form must be the parent or legal guardian of the student *

I acknowledge that only the parent or legal guardian of the stated student may complete this form and I am the parent/legal guardian of this student

Required

Parent/Guardian Phone Number. *

Student/students who are to be transported via an adult from the venue: *

Who is transporting the student from the venue (name): *

What is the relationship of the student to the alternate transportation provided, these are the only acceptable circumstances in a non-emergency situation *

Parent/legal Guardian

Grandparent-biological or adoptive

Adult sibling- must be graduated from high school or 19 years of age

What event is the student be transported from (host opponent, location): *

Sport *

Boys Soccer

Cross Country

Golf

Girls Soccer

HS Cheer (Football)

HS Football

HS Volleyball

JH Cheer (Football)

JH Football

JH Volleyball

Required

What is the date of the event: *

YYYY

What is the reason for the alternate transportation:

Please read and acknowledge this statement in order to allow for the alternate transportation: *

I, the signer, understand that my child may be at greater risk of injury or death by being transported in a private automobile instead of a school bus and assume such risk on behalf of my child. I/we agree not to hold Northwestern Local School District and/or the school, or any of its agents or employees liable for any sum which I/we might claim as a result of injury, or property damage arising out of, or caused by any accident or occurrence during the time said student is being transported by me, or another adult from said practice, game or event in conjunction with the activities listed above.

Required

Statement on student responsability: *

I, the signer, understand that students are required to notify the Coach or Advisor that they will be providing their own transportation at least 24 hours in advance of the activity. If the Coach or Administrator decides that self-transportation for this particular event is inappropriate, the student and parent agree that the student will use the transportation provided by the district. A student granted permission to utilize transportation other than district transportation MUST personally notify the Coach or Advisor (along with the person(s) providing the transportation) prior to being dismissed form an event. No student is permitted to leave an event without first checking in with the Coach or Advisor.

Required

Statement on district discretion with alternate transportation: *

I, the signer, understand and agree that this permission to provide our own transportation is granted by the School Principal, Assistant Principal/Athletic Director and/or Advisor of the activity and can be revoked at any time at their discretion.

Required

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

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