Notification of Alternative Transportation Arrangements
As the parent/guardian of
, I hereby give my permission for
my child who is participating in the following program
to:
Be transported by private vehicle to and/or from, or dropped off and/or picked up by
another parent, relative or family friend.
Name of parent, relative or family friend
Be dropped off and/or picked up curbside as I will be picking them up, therefore
my child can sign themselves in and/or out.
Walk or use public transportation to go home, therefore my child can sign
themselves in and/or out.
The following person(s) is NOT ALLOWED to pick up my child:
Name of person(s)
Please provide a brief statement:
A photo of the person(s) can be emailed to: tracy-peterson@uiowa.edu
I hereby release, discharge and indemnify the University of Iowa, its administration, staff,
employees, officers, directors, volunteers, insurers, agents, and representatives from any and all
claims, causes of action, liability or damages arising out of, or relating to the transportation of my
child.
Signature of Parent/Guardian
Date