Private Transportation Consent Form to Attend

A+ Tutoring

Dear Parent or Guardian, and Student,

The undersigned student has received approval to be an A+ Tutor. The Student is required to provide his or her own transportation to and from the A+ tutoring site. Therefore, the School District requires that the student and their parent or guardian sign the Private Transportation Release Consent Form that appears below:

Location of Activity:__A+ Tutoring at FHSD Property

Date of Activity: ___ 2013-2014

RETURN THIS FORM TO THE SCHOOL BY:

Note: Failure to comply with these requirements may result in discipline, dismissal from the program, or loss of credit.

My child, ______, has my permission to travel from school property

(or other location) to a FHSD site by private transportation, either driver oras a passenger in a private automobile driven by another student. I understand and acknowledge that the FrancisHowellR-IIISchool District will have no financial or legal responsibility for injuries arising out of such travel.

By signing this form, I hereby release the District, as well as its directors, officers, administrators, employees, and other agents from all liability for any and all injuries arising from his/her travel to the A+ tutoring site via private transportation.

.

______

Parent or Guardian Date

______

Parent or Guardian Date

TO BE SIGNED BY STUDENTS 16 YEARS OF AGE OR OLDER IF EITHER DRIVING OR RIDING IN A PRIVATE VEHICLE TO THE A+ TUTORING SITE

I acknowledge that the District will have no financial or legal responsibility for injuries arising out of my travel from school (or other location) to their A+ tutoring site. I further acknowledge that I have a responsibility to travel directly from school (or other location) to the A+ tutoring site and that failure to report to the A+ tutoring site on time may result in discipline, up to and including possible dismissal from this program. I further acknowledge that inappropriate conduct during travel to A+ tutoring sitemay result in such discipline, as well as additional discipline under Board of Education Policy, as such Policy applies to out-of-school misconduct.

______

Student Signature Date