Trigg Street Church

Transportation Permission Slip

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.

Parent/Guardian

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Child(ren) Name(s)

Please list all children of your household who have your permission to be transported by church staff and volunteers.

Do any of the children above have special need/alleries?

Yes

If yes, please list their name and their special need/allergy:

If you cannot be contacted in the event that your child(ren) need to be pick up from church for any reason or there is an emergency, who should we call?

Name Relationship to Child(ren) Contact Number

I hereby give my permission for all the children listed above to ride the van or other vechicles 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 Trigg Street Church of God 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 that staff or designated medical professionals and/or volunteers to administer emergency medical assistance, if I cannot be reached.

Sign (Type your full name)

Date

YYYY