ALTERNATE TRANSPORTATION REQUEST THIS FORM MUST BE COMPLETED AND

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090115 100C233 ALTERNATE PAVEMENT SECTIONS PRESENT VALUE COST AND
330601D1 ALTERNATE WORK SCHEDULES AND LOCATION FOR NON FACULTY

ALAWDA AND ALTERNATE FOCUS FIRST ANNUAL VIDEO CONTEST
ALTERNATE ACCESS PLAN PURPOSE OF THE ALTERNATE ACCESS
ALTERNATE ASSIGNMENT FOR SCHINDLER’S LIST OSKAR SCHINDLER WAS JUST

ALTERNATE TRANSPORTATION REQUEST

ALTERNATE TRANSPORTATION REQUEST THIS FORM MUST BE COMPLETED AND


ALTERNATE TRANSPORTATION REQUEST

THIS FORM MUST BE COMPLETED AND TURNED INTO THE DIVISION OFFICE

(BUILDING 45), AT LEAST 3 DAYS PRIOR TO THE REQUESTED EVENT/CONTEST DATE


DATE

2/23/2012

Date is updated automatically when saved or printed


ATHLETES NAME

     

SPORT/TEAM


EVENT/CONTEST NAME

     

EVENT/CONTEST DATE

, ,

LOCATION NAME

     

LOCATION CITY, STATE

     ,


ALTERNATE MODE

OF TRANSPORTATION

REASON FOR USING

ALTERNATIVE MODE

OF TRANSPORTATION

     


As a condition of myself receiving permission/approval for Alternate Transportation to the activity above, I agree to waive all claims against the Mt. San Antonio Community College District (District) and to indemnify and hold the District, it’s officers, agents and employees, harmless from any and all liability or claims, demands, losses, causes of action, suits or judgments of any kind whatsoever that I, my heirs, executors, administrators or assignees may have against the District or that any other person or entity may have against the District because of any death, bodily injury, personal injury, or illness, or because of any loss to property that may arise out of or in any way be connected to privately transporting myself to the above described event/contest.


I further acknowledge that the District does not provide any type of insurance including liability, collision, comprehensive or medical coverage for students who provide their own transportation.



ATHLETES SIGNATURE

     

,

Please type in your name. By typing in your name, this becomes your electronic signature.

FORWARD THIS FORM TO YOUR COACH OR FILL IT OUT ON YOUR COACHES COMPUTER.

IN ORDER TO BE APPROVED, THIS FORM MUST BE EITHER SIGNED AND TURNED IN OR

ELECTRONICALLY SIGNED AND E-MAILED FROM THE HEAD COACHES MT. SAC E-MAIL ACCOUNT.


APPROVAL ELECTRONIC SIGNATURE


HEAD COACH NAME

     

Approved Not Approved

DATE

,


Please type in your name. By typing in your name and sending this via your Mt. SAC e-mail account, this becomes your electronic signature.


DEAN OR DESIGNEE NAME

     

Approved Not Approved

DATE

,


Please type in your name. This is your electronic signature.


Revised 3/7/2022 @ 10:05 PM Page 1 of 1


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Tags: alternate transportation, for alternate, transportation, request, alternate, completed