Breck Road Transportation Consent Form

Transportation Consent
Gospel Mission in Welshpool | Saturday, 25 January | Lifts Start at 3.00 pm
I give my permission for my young person(s) to be transported to and from the stated activities sponsored by Breck Road Baptist Church. I understand that my young person(s) will be transported to/from the adresses on this form. I consent for them to travel in the transportation provided and participate in the activites at the stated event. I do not hold Breck Road Baptist Churc responsible for any injury or loss/damage of property.

From:
Breck Road Baptist Church
Dobson Street
Liverpool
L6 2JG

To:
Welshpool Gospel Mission at The Old Chapel
New Street
Welshpool, Wales
SY21 7SF
Name of Child/Youth:
First NameSurname
Name of Child/Youth
First NameLast Name
Name of Child/Youth
First NameLast Name
Parent/Legal Guardian Mobile No.:
Name of Parent/Legal Guardian:
First NameSurname
Date:
DayMonthYear
Signature of Parent/Legal Guardian:
Clear
Should be Empty: