Student Transportation Permission Form

Student Name _________________________________________________________

Address______________________________________________________________

Phone Number_________________________________________________________

FWBHS Event__________________________________________________________

Dates of Event__________________________________________________________

Purpose: To provide the consent of parents and/or guardian of student to be released to the adult noted on this form and be transported by private vehicle to and/or from FWBHS events.

I, __________________________________________ hereby grant permission for my

(parent/guardian)

child, _______________________________________ to be released

(child)

to _________________________________________ to provide transportation

(authorized adult)

to ______________________________ and/or from ___________________________

(location) (location)

back to Fort Walton Beach, Florida.

I, _____________________________________ hereby release the Okaloosa County

(parent/guardian)

School Board, its officers and employees from any liability associated with the above transportation arrangements.

______________________________ ____________________________________

Date Parent or Guardian Signature

STATE OF FLORIDA – COUNTY OF OKALOOSA

The foregoing instrument was acknowledged before me this _____ day of ___________

by _____________________________________ who is personally known to me or has

(Name of Person)

produced ______________________ as identification and who did/did not take an oath.

(Type of Identification)

_________________________________ ________________________________

Signature of Notary Printed Name of Notary

Title or Rank ______________________________

Notary Expiration or Serial Number ______________________________