Release Of Liability Waiver

East Side Baptist Church Transportation Permission Form

This form is to be completely filled out and signed by parent or legal guardian before any child or youth under the age of 18 may be transported by church staff or volunteers for any church event. Permission will remain active until revoked by parent or legal guardian. If a child is dropped off for an event requiring transportation, that is considered permission for that particular event.
NAME OF EVENT*
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Please upload a copy of child's health insurance card. Photo must include Insurance Carrier and Policy Number. *

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Please write the Health Insurance Carrier & Policy Number.*
Please list all children of your household who have your permission to be transported by church staff and volunteers for church events. Please note that the church van, rental vehicles, and personal vehicles all may be used for the transportation of groups. All drivers of minors for church events have undergone a criminal background check.
Please list each child and include their date of birth.
I hereby give my permission for all the children listed above to ride the van or other vehicles used for church functions. I understand that my children will be under adult supervision. I further understand that in signing this form, I release and hold harmless East Side Baptist Church and all other church-related functions. By signing this form, I release and hold harmless its trustees, officers, employees, interns, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached.
Signature*

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Signed by*

First NameLast Name
Relationship to child
Date*

MonthDayYear
Date
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East Side Baptist Church Transportation Permission Form