Butte School District

8101F-1

Student Transportation Liability Release Form

The Butte School District encourages district students to attend off site activities. As a part of these activities, there are times when staff and volunteers using their personal vehicles may transport students. It is the policy of the Butte School District to require parental permission before allowing a student to travel in these situations. If you would like your child to participate, please carefully read and sign this document.

I hereby give permission for my child,_____________________________________, to travel by a private car as mentioned above. As a parent or guardian, I understand that the school and the staff will try to prevent accidents. However, I fully understand that some activities involve inherent risks to students regardless of reasonable safety measures that may be taken by the district. In consideration of the district’s agreement to allow my child to travel in a private care, I agree to accept responsibility for any loss, damage, or injury to my child that occurs during my child’s participation that is not the result of fraud, willful injury to a person or property or the willful or negligent violation of a law by a trustee, employee or agent of the Butte School District.

In the event it becomes necessary for the district staff in charge to obtain emergency care for my child, neither he/she nor the school district assumes financial liability for expenses incurred because of an accident, injury, illness and/or unforeseen circumstances.

Parent or Guardian:_______________________________________________________________ (Please Print)

Signature______________________________________

Address:_______________________________________

Phone Number:__________________________________

Does your child have a medical condition that the school should be aware of before allowing your child to travel? Yes No If yes, please state the nature of the medical condition.

______________________________________________________________________________

Date:___________________