I am the parent/guardian of the above-named student of Independent School District #255, Pine Island
(hereinafter “District”). My child is a member or participant in the co-curricular activity and/or extracurricular activity of the District’s set forth above, which engages in organized activities/practices/games off campus located at the track and field complex at the K4 School and may engage in meets, matches, games, or other organized activities at other off-campus locations.
ACKNOWLEDGMENT AND WAIVER: I understand that the District may provide transportation to
co-curricular and/or extracurricular practices, games, and activities of which my child is a participant and for
which transportation its employees supervise, control, and arrange. I also understand that the District may not
provide transportation to co-curricular and extracurricular practices, games or activities for which my child is a participant. In consideration for my child being allowed to use alternative transportation for his/her or our family’s convenience or in order to participate in this co-curricular and/or extracurricular activity due to the lack of District transportation, I hereby acknowledge and agree to the following:
I understand that, while District employees will direct students in complying with the permissions provided
herein, the District will not participate in arranging such alternative transportation or otherwise supervise or
instruct student behavior while using the alternative transportation I have authorized below. Further, I
understand that, with respect to the alternative transportation I have authorized herein, the District makes no representations or assurances regarding the safety or condition of any vehicles used, insurance coverage, the driving skill or licensure of any driver, the legalities of passengers riding with any driver, any driver’s compliance with relevant traffic or other laws, or the availability of any insurance for the alternative
transportation I have authorized. I represent that my child is capable of safely participating in the activities I
have permitted. I understand that the District, despite not supervising or controlling the alternative
transportation, may unilaterally revoke the permission granted below if it believes that it is in the best interests
of the student(s), driver, passenger, or public. I further understand that this waiver and acknowledgment applies to all co-curricular activities and extracurricular activities in which my child chooses to participate, including any circumstance in which my child chooses to participate in activities of the team/activity for which no District-arranged transportation is provided, including practices, meets, matches, games, or other organized
activities at other locations, in consideration for being permitted to participate in said activities, or for which I
provide or authorize another family member or participant’s parent to provide my child with transportation for purposes of our convenience.
I recognize and understand that these activities have inherent risks including the potential loss of personal
property and the risk of physical injury or death. Knowing these inherent risks, I am voluntarily assuming such risks and granting permission for my child to participate in the activities identified below.
I, on behalf of myself, the above-named student of the District, and any personal representatives, heirs,
executors, administrators, agents, and assigns of myself or the above-named student, hereby voluntarily and
forever release, waive, discharge, and covenant not to sue the District, its board members, administrators,
employees, agents, representatives, and volunteers (“the Released Parties”), jointly and/or severally, from any
kind of liability, including any and all claims, demands, injuries, damages, causes of action (known or
unknown), suits, or judgments of any and every kind (including attorneys’ fees), arising from any injury,
property damage, or death that any undersigned may suffer as a result of participating in the activity identified
below, regardless of whether the injury, damage, or death is caused, in whole or in part, by the Released Parties or the Released Parties’ negligence, unless the injury, damage, or death arises from the Released Parties’ gross negligence, willful misconduct, or claims that cannot be waived under Minnesota law.
I further agree to indemnify, and save and hold harmless the Released Parties, jointly and severally, from any
and all claims, causes of action, liabilities, damages, costs, and expenses, including attorney’s fees, arising from the above-named student’s participation in the activity identified.
Typing My Name Below as my signature indicates that I am agreeing to the above conditions.
