Kokomo Bus Transportation Request
Please complete this form if your child needs bus transportation to or from Kokomo.
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KOKOMO AREA BUS STOPS PARENTAL AGREEMENT
The Kokomo Area Bus Stops are made available as a courtesy to Out of District students enrolled at Eastern Howard School Corporation for your convenience. These bus stop locations were approved by the local churches with the requirement that a parent or guardian would be present while students were waiting for the school bus each morning, and would be present to receive their student when returning after school.
Please sign this form agreeing to:

- DO NOT MOVE VEHICLE WHILE FLASHING LIGHTS ARE ACTIVATED AND DOOR IS OPEN

- Be present at the selected bus stop 5 minutes prior to both morning and afternoon bus stop times and/or that you will have a designated adult at the bus stop you have selected.

*Failure to follow these first two points may result in suspension of bus services

- Read and agree to follow the “Don’t Lose Your Bus Riding Privilege” rules.

- Understand that Eastern Howard School Corporation’s student behavior rules while at school also apply at the bus stop. Please see student handbook. Drivers have the option of not allowing extra riders if the bus
is at capacity.

Please enter the best phone number to reach you. *
Student 1 Name and Grade *
Separate name and grade with a comma (.)
Student 2 Name and Grade
Separate name and grade with a comma (.)
Student 3 Name and Grade
Separate name and grade with a comma (.)
Student 4 Name and Grade
Separate name and grade with a comma (.)
Student 5 Name and Grade
Separate name and grade with a comma (.)
Please indicate bus stop choice: *
Leslie Alexander, Eastern Howard Transportation Director -  765-628-5002. Please check the Eastern Howard School Corporation Web Site and Facebook page for updated information. A copy of this form is to be filed at the school office of the student, and the Transportation Office.
WAIVER AND RELEASE FROM LIABILITY FOR TRANSPORTING TRANSFER STUDENTS OF EASTERN HOWARD SCHOOL CORPORATION
I, ___________________________, the parent or legal guardian of _____________________________ HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge EASTERN HOWARD SCHOOL CORPORATION (“EHSC”) and its agents, employees, officers, directors, affiliates, successors and assigns, coaches, teachers and trustees from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to EHSC’s transportation of my child from any bus pickup sites at which my child has or will be dropped off to ride EHSC’s provided transportation (i.e. buses), provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

I acknowledge, agree, and represent that I understand the nature and risks of and associated with leaving my child, or having my child left by my agent(s), at designated bus stops and the transportation of my child to school from designated bus stops at which I or my agent(s) drop off my child in making use of EHSC’s accommodation of the transportation needs of students lacking legal settlement under I.C. 20-26-11, such as mine. I understand that transportation of my child to school, per EHSC policy, is solely my responsibility and is undertaken by the school only as an accommodation to me upon formal request and approval by EHSC. In exchange for this accommodation, on behalf of myself, my heirs, assigns, administrators, executors and next of kin, I waive all claims of personal injury and death sustained to me, my child, my property, or the property of my child, that I may have against the aforementioned released entity, including, but not limited to, claims in tort, contract, equity or otherwise.

By this WAIVER AND RELEASE, I assume any risk to my child and waive any claim for his or her personal injury, death, and/or damage to his or her personal property as a result of the EHSC’s accommodation of the transportation needs of my child.

This WAIVER AND RELEASE is the complete agreement of the parties and shall supersede any prior written or oral agreements between the parties as relates to the above mentioned activities. This WAIVER AND RELEASE may not be altered, modified, amended or waived, in whole or in part, by the parties, except by subsequent written agreement of both parties.

The waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.


Parent Name *
Please type your full name to certify that you have read and fully understand the above agreement and release of liability and contract:
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