Rutherford Tutorial Academy

Of MTHEA

DRIVING / RIDING STUDENTS PERMISSION FORM

STUDENT NAME:

_______________________________________________________

Parents:

Please initial all applicable item(s), supply all requested information,  sign at the bottom of this form and return it to one of the RTA Board members on the first day of classes. 

_____ I give permission for the above-named student to drive to/from classes.

_____ The above-named student may drive the following students in his/her vehicle:

_______________________________________________________

_______________________________________________________

_______________________________________________________

_____The above-named student may ride with the following student drivers:

_______________________________________________________

_______________________________________________________

_______________________________________________________

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PARENT SIGNATURE                                              DATE