Travel Release Form

Required

This form must be filled out by the parent/guardian and submitted at least 24 hours prior to the event/activity.

You will receive an email notification from Austin Public Schools verifying your transportation request has been approved.

If you would prefer, you can also fill out the paper version of the form and return it to the Activities office at least 24 hours prior to the event/activity.

Parent / Guardian Namerequired

First Name

Last Name

Parent / Guardian Emailrequired

Student Athlete Namerequired

First Name

Last Name

Sport / Activityrequired

Date of Eventrequired

Must contain a date in M/D/YYYY format

Location of Eventrequired

Who will be transporting the above named student?required

Parent/guardian

Someone other than parent/guardian

I will be transporting the above named studentrequired

Declarationrequired

I certify that I am personally transporting the above-named student and that I am the legal guardian of that student. Students may under no circumstances ride with anyone other than their legal guardians or drive themselves to or from any event.

In consideration of Austin Public Schools allowing me to provide alternative transportation, rather than use school transportation, I agree to voluntarily assume full responsibility for, and the risk associated with, the transportation and voluntarily and forever release, waive, discharge, and covenant not to sue Austin Public Schools, unless the injury or damage arises from Austin Public Schools’ gross negligence, willful misconduct, or claims that cannot be waived under Minnesota law. I further understand that my automobile insurance is the only insurance coverage applicable in the event of any accident or injury related to my transportation of student and certify that I have a valid driver’s license and automobile insurance, as required by law.

Name of individual providing transportation.required

First Name

Last Name

Email or telephone number of individual providing transportation for above named student.required

The individual providing transportation will be transporting the above named studentrequired

Declaration

I certify that I am the legal guardian of the above named student.

I hereby release the District, its officers, agents, and employees from any liability for damages from illness, injury, and/or death that arises out of, or is connected with, or in any manner relates to the release of the Student from the District's supervision on said field trip. The mutual promises and agreements contained in this document, the Parent, the Student, and the District hereby agree as follows:

The Parent and Student are submitting this release, waiver of liability, and assumption of risk declaration voluntarily and their own free will.
The Parent and Student understand and EXPRESSLY ASSUME all the dangers incident releasing the Student from District supervision, and hereby RELEASE ALL CLAIMS, including but not limited to, personal injury, property damage or destruction, and death, whether caused by NEGLIGENCE, breach of contract or otherwise, and whether for bodily injury, property damage or loss otherwise, which they may ever have against Austin Public Schools, its officers, agents, and employees.
The Parent and Student hereby agree that thus Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence and is intended to be broad and inclusive as is permitted by the laws of Minnesota and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I acknowledge I have read and fully understand the terms of this agreement and I intend to be legally bound by its terms.

Students may under no circumstances ride with anyone other than the individual listed or drive themselves to or from any event.

Katie Carter
Activities Director
507-460-1825
katie.carter@austin.k12.mn.us

Kelly Joseph
Activities Secretary
507-460-1825
kelly.joseph@austin.k12.mn.us

Kayla Dose
Athletic Trainer
507-460-1825
uptagrafft.kayla@mayo.edu

Brandon Bartness
Facility Services Manager
507-460-1927
brandon.bartness@austin.k12.mn.us