ALTERNATIVE TRANSPORTATION AUTHORIZATION
(FOR STUDENT DRIVERS & PASSENGERS
REQUESTING TO RIDE WITH NON-SIBLING DRIVERS)
Parents and school districts typically provide transportation to and from school, and Cornerstone Prep generally provides
3025extracurricular
Washington Road,
Suite 330
transportation to and from field trips, athletic events and other
activities
whenever possible. There are
McMurray,
PA
15317
instances however, when a student may need to ride to/from school field trips, athletic events or other extracurricular
Phone: (412)580-3393 Fax: (412)466-3772
activities with a student driver that is not a sibling of the rider. To do so, both students must have prior written permission of
parents/guardians, and a school administrator as endorsed on this form. The student driver must also have a completed
STUDENT DRIVER AUTHORIZATION FORM on file in the school office.
In order for Cornerstone Prep to grant a student approval to ride with another student, the Student Rider, along with their
Parents/Guardians, must review the following conditions.
1. The Student Driver must have provided the school with evidence of
 A valid Pennsylvania Drivers License and
 Up-to-date proof of insurance.
2. The Student Driver may not transport other students (except siblings) to or from school routinely unless
the transportation is necessary for the unrelated student to be able to attend school or extracurricular
activities. All students must have administrative approval for this option.
3. The student driver may only drive non-siblings if the Permission Form for Student Drivers and this
permission form have both been completed and approved, and are on file at the school office. Both forms
must include the signature(s) of students and all parents/legal guardians of students regarding
permission to ride with the student driver.
4. The Student Driver and riders agree to follow the rules established by the field trip administrator/staff and
their parents.
5. The Student and Parents/Guardians acknowledge that there are inherent risks and liabilities
involved in students riding in a vehicle with a student driver. The Students and
Parents/Guardians agree to take full responsibility for the Student(s) riding to/from school or
related activities, including any personal or property damage. The undersigned
Parents/Guardians agree not to hold the School, its board of directors or employees, liable for
any accident, injury, or consequences of any inappropriate behavior that could occur from, or be
related to, the Students driving/riding to or from a school related activity. In addition, I agree not
to assert against the Cornerstone Christian Preparatory Academy, all current, former and future
members of the School Board, former or future employees of the school, its heirs, executors,
administrators, successors, and assigns, in any court of law, any claim or claims that the student
and/or parent(s) or legal guardian(s) 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. (COMPLETE REVERSE SIDE OF THIS REQUEST)
Changing lives are living proof (John 8:31-32)
3701 Brownsville Road, South Park, PA 15129
Phone: (412) 835-1100 Fax: (412) 835-1106
www.cornerstoneprep.net
Authorization to Leave Campus and Release of Liability
The undersigned, as Parents/Guardians of ________________________________________, a student at
Cornerstone Prep, hereby acknowledge the request for permission for the above-named student to arrive
or leave the campus for the limited purposes initialed below: (by student, parents and guardians)
Check all that apply
Student Drivers:
__________
To drive to and from school only in the family or student’s vehicle
_____ only with sibling passengers
_____ with other passengers designated here:
__________
To drive to and from extracurricular activities or non-school-related before or after school
purposes in the family or student’s own vehicle
_____ only with sibling passengers
_____ with other passengers designated here:
Student Riders:
__________
To ride with a student driver to and from school in the family’s or student’s own vehicledesignate permitted student drivers here:
__________
To ride with a student driver to and from extracurricular activities in the family’s or student’s
own vehicle- designate permitted student drivers here:
If Student to drive or ride with a Student Driver has two parents/legal guardians, BOTH must sign!
If the Student Driver or Rider violates the law, motor vehicle law, or any of the provisions of this authorization form, the
Student will forfeit the right to drive or ride to/from School or school related events for the school year. By signing below the
Parents/Guardians hereby give permission for the Student named below to drive or ride to or from school as selected
above. The Student and parent/Guardian hereby agree to all conditions stated above.
______________________________________
Signature of Parents/Legal Guardian
Date:_____________________
______________________________________
Signature of Parents/Legal Guardian
Date:_____________________
______________________________________
Signature of Student Driver
Date:_____________________
SCHOOL USE ONLY:
______________________________________
Signature of Administrator
Date:_____________________
3025 Washington Road, Suite 330
McMurray, PA 15317
Phone: (412)580-3393 Fax: (412)466-3772
Changing lives are living proof (John 8:31-32)
3701 Brownsville Road, South Park, PA 15129
Phone: (412) 835-1100 Fax: (412) 835-1106
www.cornerstoneprep.net