File: EEAG-E
TRANSPORTING STUDENTS IN SCHOOL OWNED VEHICLES
RELEASE FORM
I, , am the Parent/Guardian of .
Print Parent Name Print Student Name
I want my child to participate in certain opportunities, such as vocational, community-based and/or athletic activities by traveling to . My child’s teacher / teaching assistant/aide, employed by the West Springfield Public Schools (WSPS), is willing to transport my child to and from the school site/work site to these opportunities.
I understand and agree that the employee will be using either a WSPS van which does not have the markings/equipment of a school bus and/or other vehicle owned by WSPS to transport my child. I am willing to have the employee use the WSPS owned vehicle to transport my child. I consent to my child’s participation in this form of transportation. In consideration of my child’s being permitted to so participate, I, on behalf of myself and my child, release and agree to hold harmless the Town of West Springfield Public Schools and its employees from any claims or actions in any way related to this transportation/participation. In addition, I, on behalf of myself and my child, agree to indemnify the WSPS and its employees in the event that I/my child have any claim or action relating in any way to these activities/transportation.
Name of Event(s) Date of Event(s)
Signature of Parent/Guardian Today’s Date
cc: High School Principal
Director of Maintenance
Superintendent of Schools
SOURCE: Attorney Tate (April 2011)
REF: Student Transportation in Private Vehicles (File: EEAG)
Reviewed & approved: October 31, 2013 [Policy Subcommittee]