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Series 604.1.2P - Release of Liability for Student Transportation To or From Cocurricular Activities


Parents/Guardians/Adult Students (Age 18 and Older):

          If your student (or you, if you are a student age 18 or older) plans to participate in cocurricular activities, please complete and sign the following form, and return it to the student’s coach or advisor.

(Student’s name)                                                                                                             

(please print)

has my permission to participate in cocurricular activities during the                  school year and I understand that it is my sole responsibility to arrange for my student’s transportation to and from cocurricular events.  I understand that Independent School District 196 and

                            High School may arrange for transportation from time-to-time, but on all other occasions transportation remains my sole responsibility.

          I agree for myself and on behalf of my student to waive all liability and to release and hold harmless District 196, its School Board members, agents, employees, and volunteers in the event of injury death, loss or damage to person or property that occurs as a result of my student’s transportation to or from a cocurricular activity by transportation other than that provided by District 196. In addition, I agree for myself and on behalf of my student, not to assert against the District, its board members, agents, employees or volunteers, in any court of law, any claim or claims whether known or unknown, that arise as a result of such transportation. I understand that this release and waiver of liability applies to claims caused by District 196’s own negligence, but not by the willful or wanton misconduct of District 196, its board members, agents, employees or volunteers.

          I have read and voluntarily sign the release and waiver of liability, and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

Signature of Parent, Guardian or Adult Student:                                                                 (Date)

School Use Only

Received by                                                                       Date                                       

Copy to Principal