Parental Permission Form And Release Of All Claims printable pdf download

Parental Permission Form And Release Of All Claims

Florida Sheriffs Association Teen Driver Challenge

PARENTAL PERMISSION FORM AND RELEASE OF ALL CLAIMS

STUDENT INFORMATION

Name of Student ____________________________________________Age __________

Name of School Currently Attending _________________________________ Grade ________

Date of Birth ________________

Name of Parent/Legal Guardian ___________________________________________________

Address _______________________________________Telephone Number_________________

Does your child require a reasonable accommodation to safely operate a vehicle? If so, please indicate

the accommodation:_______________________________________________________

Is your child under the influence of any medication that could affect his/her ability to operate a vehicle?

________

*****************************************

I have been informed that my child’s full name, address, date of birth, and driver’s license number will be

released to the Florida Sheriffs Association Teen Driver Challenge upon request.

I hereby give my consent for the above-named student to participate in the FSA Teen Driver Challenge

offered by the Pinellas County Sheriff’s Office.

I state this consent is given with the understanding that:

(1) The training course involves moving vehicles being operated by inexperienced drivers.

(2) My child will be operating a vehicle that is not owned by PCSO or any governmental agency, the

vehicle is individually owned.

(3) Damage may occur to the vehicle that the above-named student is driving or to other vehicles

involved in the course.

(4) The above-named student’s participation in this course subjects the student to a risk of serious,

catastrophic, permanent injury, or even death.

If I am not the owner of the vehicle which the above named student intends to use while taking this

course, I hereby certify that the owner has consented to the use of his/her vehicle and has authorized the

use by completing the VEHICLE OWNER’S STATEMENT OF PERMISSION AND RELEASE OF

ALL CLAIMS attached. I further certify that the vehicle which the above-named students will use in this

course is in good working order, including the vehicle’s engine, brakes, suspension, steering and tires.

Parental Permission Form And Release Of All Claims