UNION STUDENTS TRANSPORTATION FORM

UNION STUDENTS CONSENT AND LIABILITY RELEASE FORM

_________________________________________________________________________________________

CONSENT FOR ALL PARENTS OR LEGAL GUARDIANS OF CHILDREN WHO ARE PARTICIPATING IN ANY ACTIVITY WITH UNION CHURCH.

I consent to allow any of my children listed below to participate in an activity, event or program sponsored by Union Church. In the event of an emergency where medical treatment is necessary, I authorize Union Church to obtain the services of a licensed physician and/or certified paramedic for me and/or any of my children listed below. I agree that any such expense will be my obligation.I have provided phone numbers below that may be used in the event of an emergency. I agree to update these contact numbers if there is a change.

__________________________________________________________________________________________
Contact Information
Parent or Legal Guardian (Print) *
Phone Number *
Please enter a valid phone number.
Email Address *
example@example.com
Parent or Legal Guardian Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of Child (1) *

First Name Last Name
Age *
Name of Child (2)

First Name Last Name
Age
Name of Child (3)

First Name Last Name
Age
Name of Child (4)

First Name Last Name
Age
Date *

Month Day Year
Date
Signature *

Clear

LIABILITY RELEASE TO BE SIGNED BY INDIVIDUAL OVER THE AGE OF 18 or PARENT/LEGAL

I, (Please Print) _______________________individually, or in my capacity as a parent or legal guardian of the above listed child(ren), hereby provide a full and complete release of any liability and indemnification, past or future, which may be claimed against Union Church, and its agents, trustees, officers, employees, members, attendees, representatives, any volunteers and specifically includes all claims and demands of whatever nature, actions, damages, costs, loss of services, expenses and compensation on account of or in any way growing out of personal injuries, illnesses, and/or property damage having already resulted or to result at any time in the future, whether or not contemplated at the present time or whether or not they arise following the execution of this release. For the consideration stated above, I further agree that in the event that my child or I should make any claim against Union Church for damages arising out of the above-named activity, we will personally indemnify, defend, and hold harmless, and its agents, trustees, officers, employees, members, attendees, representatives, and any volunteers against any and all loss and damaged occasioned thereby, including attorney's fees.

I understand that Union Church may take photographs of me, my child(ren) and my family in the course of its activities, and I grant Union Church permission to publish such photographs in a manner Union Church deems appropriate.

This Liability Release Form is in effect for ALL events or activities that I, or any of my children, may participate in. This release form is revocable, prospectively only, by a writing signed by me that bears the date that the revocation is delivered to Union Church.
Date *

Month Day Year
Date
Parent/Legal Guardian Signature *

Clear
Campus Pickup Location *
Please selection your pickup Location
Should be Empty:

Contact Information