Activities Travel Release Form

	A	G	H	K	M	O	P	R	T
1	KEYA PAHA COUNTY SCHOOLS
2	ACTIVITIES TRAVEL RELEASE
3									Date:
4
5	This is to certify that					has my permission to ride to / from the
6		(student's name)
7			today at				with
8	(Activity)			(Location of Event)				(Parent or Designated Adult)
9
10	I certify that I am personally responsible for the change in transportation for the above named
11	student.
12
13	I understand that the Keya Paha County Schools and the Keya Paha Board of Education
14	require that students ride school provided transportation to and from all activities and a departure
15	from this requirement will release the Keya Paha County Schools and the Board or Education
16	from any liability for any adverse results that may occur.
17
18	I agree to release the Keya Paha County Schools and its employees and Board of Education
19	from any liability with reference to the above stated transportation.
20
21
22	(Signature or Parent or Guardian) Required				(Date)
23
24
25	(Signature or Other Designated Adult Driver) Required if other that the Parent							(Date)
26
27
28	KEYA PAHA COUNTY SCHOOLS
29	ACTIVITIES TRAVEL RELEASE
30									Date:
31
32	This is to certify that					has my permission to ride to / from the
33		(student's name)
34			today at				with
35	(Activity)			(Location of Event)				(Parent or Designated Adult)
36
37	I certify that I am personally responsible for the change in transportation for the above named
38	student.
39
40	I understand that the Keya Paha County Schools and the Keya Paha Board of Education
41	require that students ride school provided transportation to and from all activities and a departure
42	from this requirement will release the Keya Paha County Schools and the Board or Education
43	from any liability for any adverse results that may occur.
44
45	I agree to release the Keya Paha County Schools and its employees and Board of Education
46	from any liability with reference to the above stated transportation.
47
48
49	(Signature or Parent or Guardian) Required				(Date)
50
51
52	(Signature or Other Designated Adult Driver) Required if other that the Parent							(Date)