I, ______________________________, acknowledge that I am the owner and operator of

                        (name)

the __________________________________________, which will be used to transport

                     (make, model and vehicle identification number)

students from Ayden-Grifton High School to and from ___________________________

                                                                                                                                                     (school activity)

on ________________________. I further acknowledge that I accept responsibility for

          (date of activity)

any and all claims and liability arising from the transportation of students by me. I agree to hold Pitt County School Board of Education, its officers, agents and employees harmless from said claims and liability. I further acknowledge that I have a good driving record and that the vehicle listed above is in proper working order.

This is the ________ day of _________________, 20_____.

                                                                                                ________________________

                                                                                                   (signature)