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BRIEN MCMAHON HIGH SCHOOL

ATHLETIC DEPARTMENT

 

ALTERNATE TRANSPORTATION REQUEST FORM

 

 

This is to request that __________________ be permitted to ride by vehicle other than the school bus

                                    Name of Athlete

 (to/from/both ways) at the _____________________________on ____________________ at

   Circle One                                        Activity                                               Date

 

____________________________.  I certify that I have arranged transportation for the above-named

Location of Activity

 

student.   He/She will be riding with ___________________________________, _________________,

                                                                         Name of Driver                                   Relationship

 

a responsible adult.  The reason for not riding the bus is _____________________________________

 

___________________________________________________________________________________.

 

 

I understand that Brien McMahon High School rules require that students ride the buses to and from all school events and that by requesting a departure from this requirement I will release the Norwalk Board of Education and City of Norwalk from all liability for any accidents that may occur.  I understand that I (or the other parent or guardian driving the vehicle) assumes all liability for this alternative transportation under our personal automobile insurance policy.

 

I therefore agree to release the Norwalk Board of Education and the City of Norwalk and its employees and officers from all liability with reference to the above stated alternate transportation.

 

This form must be in the Athletic Office prior to or on the day of the event.

 

 

_________________________________________              ________________________

        Parent or Guardian                                                                   Date

 

 

 

 

_________________________________________

         Athletic Director