MIDDLE SCHOOL OF THE KENNEBUNKS CONTEST TRAVEL RELEASE (MAKE ADDITIONAL COPIES) Date:______________ This is to certify that _________________________________ has my STUDENT’S NAME

permission to ride (TO-FROM-BOTH) the_________________________ CIRCLE ONE

TEAM STUDENT IS ON

athletic contest on ______________ at _________________________. I certify that I am personally transporting the above student, or have arranged for transportation with an adult (non-student) of my choosing for this student. The reason for not riding the bus is:______________________________________________________________ ________________________________________________________________ ________________________________________________________________. I understand that that Regional School Unit #21 (RSU #21) requires that students ride the buses to and from all athletic events and a departure from this requirement will release the RSU #21 from liability for any adverse results that may occur. I agree to release RSU #21 and its employees and officers from all liability with reference to the above stated transportation. This form must be on file with the Athletic Director one day prior to the day of the contest. Date received by Athletic Director:___________________________ ________________________ SIGNATURE OF PARENT/GUARDIAN

________________________ SIGNATURE OF ATHLETIC DIRECTOR

APPROVED NOT APPROVED KHS FORM NO. 07

___________________________ PHONE NUMBER YOU CAN BE REACHED AT