EMORY UNIVERSITY
TRAVEL RELEASE REQUEST
Travel release waiver is for a student-athlete to be released to parent/guardian care while on a
University sponsored trip. This signed form must be on file prior to the trip. Parental signature is
required on this form if the student-athlete is under the age of 18 on the date of the trip. If the studentathlete is 18 or older, this form must be signed by the student, coach and university athletic
administrator.
Print form – sign – fax to Head Coach at 404-727-4989.
Student-Athlete
Varsity Team
___
Destination _________________________________ Trip Date(s) __________________________
Use this section if student-athlete is 18 or older. All three signatures are required for release
to be granted.
I release the Department of Athletics and Recreation and Emory University from any damages
incurred while I am under the care of my family. My accident/health/medical insurance will be in
effect while I am away from the team and in the care of my family.
Student-Athlete
Date
Head Coach
Date
Athletic Admin.
Date
Use this section if student-athlete is under 18. All four signatures are required for release
to be granted.
I would like to request from the Department of Athletics and Recreation at Emory University that my
son/daughter to be released into my care. I fully accept the responsibility for his/her safety and wellbeing. My accident/health/medical insurance will cover him/her while away from the team and under
my care.
Parent/Guardian
Date
Student-Athlete
Date
Head Coach
Date
Athletic Admin.
Date