We recommend that you keep a copy of the signed form for your reference.

Athlete’s name: ____________________________________________________________________

Please state destination of trip:

Date: _________________________________________

I, ____________________________________________________ ,do hereby give my daughter/ward,

____________________________________________________________________________________

Permission to ride in the car of ___________________________________________________________

From __________________________________ to ___________________________________________.

Prior to this trip, I may be reached at the following telephone number _____________________________________________________________.

I understand that Pacific Coast Volleyball Academy assumes no responsibility for my daughter/ward during this period of absence from home, and

I hereby expressly release Pacific Coast Volleyball Academy from any and all such responsibility.

Parent’s/Guardian’s signature:

______________________________________________________________Date:___________________