Permission slip for alternate transportation
(Revised 7/11/06)
Student’s Name:________________________________________
(please print)
Activity/Game Date:_____________________________________
Location:______________________________________________
(
4 check and fill out one of the two options below)Option #1
❏ I, ______________________________________, hereby request to transport and take full(Parent/Guardian - please print)
responsibility for transporting, ___________________________________________
FROM(Student - please print)
the above location in lieu of Student Transportation Specialist.
Option #2
❏ I, __________________________________________________, hereby give permission for(Parent/Guardian - please print)
_______________________________________ to transport and to take full responsibility
(Name of other Parent/Guardian - please print)
for transporting,
_______________________________________________________ FROM(Student - please print)
the above location in lieu of Student Transportation Specialist.
___________________________________________
(Parent/Guardian signature and date)
___________________________________________
(School Administrator signature and date)
Received by Sponsor/Coach:_______________________________________________________
Date:______________________________________________________
This form must be signed and filled out in its entirety before turning it in to the sponsor/coach within 24 hours.
❏