The athlete’s parent or guardian must complete this form each time that the request is made.
My son/daughter _______________________ has my permission to be transported in a privately
(Name: First, Last)
owned vehicle on _______________________. The activity is _____________________________
(Date: MM/DD/YYYY) (Name of event)
To be held at ____________________________ in __________________, ________.
(Building or school or facility) (City) (State)
The driver of the vehicle will be ______________________________
(Name:
First, Last)
The registered owner of the vehicle is _________________________
(Name:
First, Last)
of _________________________in ____________________, _________.
(House number and street) (City) (State)
Signature of parent or guardian ____________________________
Printed name of parent or guardian ____________________________
Date ___________________
(MM/DD/YYYY)
NOTE: If this form is not presented in person by the parent/guardian, the signature must be verified by a telephone call from the person in charge of travel arrangements to the parent/guardian..
30-8 PACE
(Adapted from the Program for Athletic Coach’s Education or PACE)
(Rev Nov. 2004 CJI)