Permission Slip for Alternate Transportation

(Revised 7/11/06)

Student’s Name:________________________________________ (please print) Activity/Game Date:____________________________________ Location:______________________________________________
❏(check the box 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.