REQUEST FOR PERMISSION

The said Student and Parent listed below request the Pickens County Board of Education, Superintendent, Principals and other agents, servants or employees of The Board (hereinafter collectively referred to as School System) to grant permission so that Student may be allowed to drive a motor vehicle from the home school or from the Pickens County College & Career Center to the Work-based learning work training site.

The undersigned expressly authorize such travel and represent to School System that Student has in effect a valid driver’s license issued by the State of Alabama allowing Student to drive which is not so, there is in full force and effect a policy of liability insurance covering such motor vehicle in such amount as required by the State of Alabama. Such insurance (or comparable policy) will be kept in effect so long as Student remains enrolled in the Pickens County School System. Attach a photocopy of Student’s driver’s license and insurance card or other proof of liability coverage.

In the event of suspension, cancellation or revocation of either the driver’s license or insurance policy, the undersigned shall immediately notify School System. In such event, any permission granted by School System to Student shall immediately terminate.

The undersigned voluntarily release and waive any and all claims against School System, both present and future, arising out of or in any way connected with Student’s use of a vehicle pursuant to this authorization including, but not limited to, claims for breach of contract, express or implied, or for acts or failure to act, or wrongful death. The undersigned do hereby release, waive and discharge School System and covenant that they will not institute any suit, claim, or action against School System for any loss, damage, or injury, to person or property, arising out of School System’s grant of permission to Student to drive a motor vehicle, whether such is caused by the Student, School System, or a third party. The undersigned also agree to indemnify and save harmless the School System against any and all claims for damages, loss or injury, costs or expenses, including reasonable attorney’s fees, that arise out of , or are made as a result of, Student’s use of a motor vehicle pursuant to this request.

The undersigned have read and voluntarily executed this document, including release, waiver of liability, and indemnity agreement. No oral representations, statements, or inducements apart from this written document have been made. We agree that this request is voluntary and the undersigned assume all risks of loss, damage, or injury that might be sustained as a result of Student’s operation of a vehicle pursuant to permission granted by School System.

The undersigned agree that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Alabama, and that if any portion is held invalid, the remaining provisions shall continue in full force and effect