Golden Valley

High School

2121 East Childs Avenue

P.O. Box 2188
Merced, CA 95344
(209) 385-8000
Admin FAX (209) 385-8002

Principal
Constantino Aguilar
Associate Principal
Guidance
Jennifer Euker

Associate Principal
Student Support
Abraham Olivares

School Psychologist
Megan Whitley

Associate Principal
Student Services
Michael Richter

Associate Principal
Assessment\Accountability
Matt Thomas

Athletic Director
Bill Hurst
Activities Director
Laura Diele

STUDENT SELF-TRANSPORTATION REQUEST

I, ________________________________, request the opportunity to provide my own transportation as a daily function of
my educational program at Golden Valley High School. I will transport myself each day between Golden Valley High
School and ___________________________. I understand and agree that I will not transport any other student of Golden
Valley High School between those points or anywhere else during school hours. I acknowledge that if found in violation
of this agreement, I will lose the privilege of self-transportation.

___________________________________

_______________________________________________

Date

Student Signature

I, ________________________________, as parent/guardian of the above named student, give my permission for my

student to transport him/herself daily between Golden Valley High School and ____________________. My student will
walk, be picked up, or drive**. Student who drive must provide proof of their license to drive in the State of
California (CA license # _ _ _ _ _ _ _ _ ). The vehicle my student will drive is covered by the following insurance
company: ________________________________________________ Policy # : _____________________________.
My student, I, and any other member of my students estate agree to hold harmless the Merced Union High School
District, Golden Valley High School, and any and all employees of either organization in the event of any litigation should
arise as a result of any accident, activity, or occurrence which may arise from this agreement.

___________________________________

_____________________________________________

Date

Parent Signature

_______________________________________________________

_________________________

Associate Principals Authorization

Date

**If you have indicated drive above, you must also show:
Student ID

Proof of Insurance

CA Drivers License

GV Parking Permit

For Office Use Only:

Stu ID#:

Grade:

Periods:

6 7 Reason: