VOLUNTARY TRANSPORTATION:
(Complete only if driving separately)
An adult student (over 18 years of age) may use his or her own private vehicle on a voluntary basis provided the student
agrees to hold the college harmless, show evidence of insurance, current vehicle registration and a valid drivers license,
no less than 3 working days before such use. Such use shall not be allowed for field trips without prior approval of the
responsible department manager, department chairperson or division chairperson.
I understand the District may be providing transportation to and from the above activity, however, I may not wish to avail
myself of the transportation provided by the District. Please explain reason:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
The above student hereby requests permission to provide for his/her own transportation at his/her own expense.
It is fully understood and agreed that the District is in no way responsible, nor does the District assume liability for any
injuries, losses or death, resulting from this non-District sponsored transportation. Although the District may suggest
travel times, routes, or caravanning to or from this event, I fully understand that such suggestions are not mandatory.
Driver’s License #: ___________________________ Exp. Date:_______________________
Year/Make of Auto: __________________________ Insurance Carrier/Agent: _______________________
Policy #: ___________ Liability Limits: ___________ Exp. Date: _________ Phone:____________________
Driving Restrictions (If any)___________________________________________________________________
_______________________________________________________________________________
I understand that any violation of this agreement may result in disciplinary action as defined in the SBCC Standards of
Student Conduct approved above. To the greatest extent allowed by law, student shall indemnify, defend and hold
District, its officers, agents, employees, volunteers, and Board of Trustees harmless from all claims, demands, liabilities,
judgements, losses, damages, and costs (including payment of all attorney’s fees and expert fees) of every kind or
nature arising out of or in connection with the field trip.
I have read and agree to abide by all the terms set forth in this agreement.
STUDENT SIGNATURE: _______________________________________ DATE:_______________
List below the NAME AND ADDRESS of parent, guardian or person to be notified in case of emergency. In the event
of a medical emergency, I authorize medical treatment deemed necessary and hold harmless any medical
facility or its personnel, Santa Barbara Community College District, its employees, or fellow students.
______ I am the parent or legal guardian of participant who is under 18 years of age to whom the above statements
apply and for whose benefit I am executing the Agreement.
I have read this waiver and I understand its terms. I execute it voluntarily and with full knowledge of its significance.
_________________________________________________________ __________________________
Signature of participant’s Parent or Legal Guardian Date
_________________________________________________________ __________________________
Print name of signatory Date
Approved:
Event Organizer: __________________________________________ Date: ________________________
District Approval Signature: __________________________________ Date:_________________________
