INDEPENDENT SCHOOL DISTRICT 196
Rosemount-Apple Valley-Eagan Public Schools
Educating our students to reach their full potential
Series Number 707.13P
October 1996 Revised August 2015
Title Release of Liability for Students Transporting Themselves Between School
Sites* During the School Day
If a high school student plans to:
1.
Drive himself/herself between school sites during the school day OR
2.
Ride with another student who is driving between school sites* during the school day,
The parent/guardian or adult student (age 18 and older) must complete and sign this form and return it to the school. * School sites include school-related activities such as offsite field trips.
(Student’s name)___________________________________________________ has my permission to drive between school sites during the school day AND/OR ride with another student who is driving between school sites during the school day for the duration of this school year. This includes trips to/from school related activities such as off-site field trips.
I agree to hold Independent School District 196 harmless in the event of injury to this student, including any property damages, while the student is driving or being driven between school sites* in a vehicle other than that provided by District 196.
In addition I agree not to assert against the district, all current, former and future members of the School Board of the district, the current, former and future employees of the district, and their heirs, executors, administrators, successors and assigns, in any court of law, any claim or claims that the student and/or the parent or legal guardian had, now have, or may have in the future, whether known or unknown, based on any injuries sustained by the student while being so transported.
I have read the above agreement, 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: __________________________________
Printed name of parent, guardian or adult student: _______________________________
Date: ________________________________
District 196 use only
Received by _____________________________________ Date _________________________
Procedure/707.13P/8-20-15