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Academy Academic Mentoring Henry Clay High School
Sponsoring Teacher Name Workman
Student Transportation Agreement
It is our understanding that , given our permission to participation in the Liberal Arts Academy Mentoring Program, will be traveling to various learning sites in the community as he/she meets with his/her mentor and works to complete his/her independent study program. He/She has our permission to drive or to travel only by the means of transportation checked below: (several options may be checked)
Lex Tran Mentor Vehicle
Personal or family automobile Other (specify)
Any other means of transportation is without sanction of the Liberal Arts Academy Mentoring Program and the student and his/her family assumes all risk.
Date
Parent Printed Name
Parent Signature
Student Printed Name
Student Signature
Return to the Liberal Arts Academy Office on or before September 10, 2007