NEWBURY PARK HIGH SCHOOL

Newbury Park, California

STUDENT PRIVATE VEHICLE TRANSPORTATION PERMISSION SLIP

Students are required to travel on buses, etc., provided by the Conejo Valley Unified School District to all school sponsored activities/ practices, events and/or games. Use of private vehicle transportation does not exempt students from payment of the District transportation fees.

1.         I am the parent/legal guardian of  (name of student)______________________________

2.         My son/daughter is a member of (name of organization)___________________________

3.         My son/daughter has my permission to (check appropriate box): Travel with me  (   ):

use his/her own vehicle (  );   travel with another parent/adult (name of adult driver) __________

on___________from (date)_______________(place of departure)_________________________

to ___________________________________(place of destination)

4.         It is understood and agreed that my son/daughter will not transport any other student in his/her vehicle.

5.         I/we agree not to hold Conejo Valley Unified School District and/or Newbury Park High School or any of its agents or employees liable for any sum which I/we might claim as a result of injury or property damage arising out of or caused by any accident or occurrence during the time said student is being transported by me or driving himself/herself, or driving with another adult to or from said practice, game or event.

6.         It is understood and agreed that permission to provide our own transportation is granted by the school Principal or Administrator of the activity and can be revoked at any time at their discretion.

7.         Student is required to notify the Administrator that they will be providing their own transportation at least 24 hours in advance of the activity. If the Administrator decides that self-transportation for a particular event is inappropriate, the student and parent agree that the student will use transportation provided by the District.

8.                  Permission will be granted only for rare and unusual circumstances! Reason is:

______________________________________________________________________________

WE HAVE READ, UNDERSTOOD, AND ARE IN AGREEMENT WITH, AND WILL ADHERE TO THE TERMS AND CONDITIONS LISTED ABOVE.

Parent Signature:___________________________________  Date:_________________

Student Signature: _________________________________   Date:_________________

Coach’sApproval: __________________________________  Date:_________________

Administrator’s Approval:____________________________  Date:_________________