LSR-7 Aquatic Center Travel Release Request Parent Transportation and Agreement Form

This following information must be completed in order for your student to participate in the Middle School Swim League program.

Student 1 Student 1 First Last
Student 2 Student 2 First Last
Student 3 Student 3 First Last
This is to certify that I will pick my student/'s listed above up at the Lee’s Summit R-7 Aquatic Center after swim practice. This is to certify that I will pick my student/'s listed above up at the Lee’s Summit R-7 Aquatic Center after swim practice. First Last
When I am unable to pick up my student/s from swim practice, I give the following individual permission to pick up and transport my student (FROM) the Aquatic Center. When I am unable to pick up my student/s from swim practice, I give the following individual permission to pick up and transport my student (FROM) the Aquatic Center. First Last
(SPORT OR ACTIVITY)
I certify that I am personally transporting my student, or have arranged for transportation with an adult (non-student) of my choosing for this student. Students cannot drive other students or ride with other students. I agree to follow all applicable district policies, administrative procedures, school rules and the rules of any sponsoring or host organization.
I understand and agree that in the event that district participation in a field trip, excursion or other off campus school-sponsored activity is canceled due to inclement weather, illness of a sponsor or other reason, any continued participation by district students is not authorized or sanctioned in any way by the district contrary to district policy, is at the sole risk of the student, and may jeopardize such student’s eligibility to engage in further participation in the activity.

(SPORT OR ACTIVITY)
I certify that I am personally transporting my student, or have arranged for transportation with an adult (non-student) of my choosing for this student. Students cannot drive other students or ride with other students. I agree to follow all applicable district policies, administrative procedures, school rules and the rules of any sponsoring or host organization.
I understand and agree that in the event that district participation in a field trip, excursion or other off campus school-sponsored activity is canceled due to inclement weather, illness of a sponsor or other reason, any continued participation by district students is not authorized or sanctioned in any way by the district contrary to district policy, is at the sole risk of the student, and may jeopardize such student’s eligibility to engage in further participation in the activity. I WILL pick my students up from the Aquatic Center and transport my student home.
I understand that if I have not picked up my student by the time swim practice is over, my student can be removed from the program.
• I (do) give my permission for my student to ride home with the following individual's.
Signature of Parent/Guardian

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Emergency Contact Name Emergency Contact Name First Last
Emergency Contact Phone Number Emergency Contact Phone Number - ### - ### ####