Department from Group
EAGLE COUNTY SCHOOL DISTRICT AUTHORIZATION FOR
STUDENT/ATHLETE DEPARTURE FROM GROUP WITH
ADULT OTHER THAN PARENT/GUARDIAN
I do hereby authorized Eagle County School District RE50J and the head coach/athletic director of the _____________________ team/group to permit my son/daughter, ________________ , To separate from the team/group on ___________________, and will be allowed to leave with ___________________ at the conclusion of today’s event held at ___________________.
I understand that I am assuming full responsibility for my child’s actions and his/her safe return to the Eagle Valley High School campus from which he/she left. Further, I do hereby waive and release Eagle Valley High School, agents and employees, including coaches and teachers, jointly and severally, of all responsibility, liability or claims for personal injury and/or property damage which may be sustained or caused by my child’s subsequent separation from the official Eagle Valley High School traveling party at the above stated date and place of event.
Phone #: ______________________________
I have advised the above student and parent/guardian that all students who leave Eagle Valley High School with a traveling team/group are expected to return to the Eagle Valley campus with the team/group. The above parent/guardian has elected that the student leave the team/group with the above stated person, who is 21 years of age or older. The parent/guardian of this student will assume full responsibility for the child’s safety and actions.
Received-Eagle Valley High School By:
__________________________________ Athletic/Activities Director