Athlete Name: __________________
Team: ________________________
Athletic Event: __________________
My son/daughter ________________________________ will not be riding the transportation provided by the Acme School and Athletic program on _____________________________(day/month/year). As of this time, _____________ (time) I release my son/daughter from the care, liability and responsibility of the bus driver and/or coach of Acme School and the Acme Athletic program.
________________________
Parent Name
________________________
Parent Signature
________________________
Date