Kingman – Norwich
115 North Main
Kingman, KS 67068
(620) 532-3134 /
Dr. Robert G. (Bob) Diepenbrock
Superintendent
/ / Max Clark
Assistant Superintendent
USD 331 KINGMAN-NORWICH CONSENT TO DRIVE
AND RELEASE AND WAIVER OF LIABILITY
1. This Consent to Drive and Release and Waiver of Liability executed on this ______day of ______, 20____ by ______(Parent/Guardian/Student age 18 or over) as Parent/Guardian/Student age 18 or over of ______(Student) in favor of USD 331, Kingman-Norwich School District (hereinafter USD 331).
2.Parent/Guardian hereby consents to allow Student to drive Student’s personal vehicle to and from ______to participate in specific classes and training. Parent/Guardian represents that student has insurance coverage, as required by law, on Student’s personal vehicle. Parent/Guardian understands and acknowledges that no USD 331 staff will be with Student during the drive to and from______.
3.Parent/Guardian does hereby release and forever discharge and hold harmless USD 331 from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity which arise or may hereafter arise from Student driving Student’s personal vehicle to and from ______to participate in classes and or/training programs.
4.Parent/Guardian understands that this Consent to Drive and Release and Waiver of Liability discharges USD 331 from any liability or claim that Student (or Parent/Guardian) may have against USD 331 with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Student’s driving, whether caused by the negligence of USD331 or its officers, directors, employees, or agents or otherwise. Parent/Guardian also understands that USD 331 does not assume any responsibility for, or obligation to, provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury of illness.
5.Parent/Guardian does hereby release and forever discharge USD 331 from any claim whatsoever which arises or may hereafter arise on account of first aid, treatment, or services rendered in connection with Student driving Student’s personal car to participate in the above-referenced program.
6.Parent/Guardian hereby expressly and specifically assumes the risk of injury or harm related to Student’s driving ad releases USD 331 from all liability for injury, illness, death, or property damage resulting from Student’s driving.
I have read and understand the foregoing Consent to Drive and Release and Waiver of Liability.
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Parent/GuardianDate