ILC Bus Rider Permission Slip
Parent/Guardian Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which Bus Route?
*
How many Riders under 18?
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
1st Child Name
*
First Name
Last Name
2nd Child's Name
First Name
Last Name
3rd Child's Name
First Name
Last Name
4th Child's name
First Name
Last Name
5th Child's Name
First Name
Last Name
Please fill out a 2nd permission slip for additional riders
Allergies / Medical Conditions
Notes
I, undersigned, agree with the following statements:
*
I am the parent/guardian of the child(ren) stated above.
I hereby give my permission for my child(ren) to ride the bus, participate in activities, and attend Inland Lighthouse Church and church-related functions.
I understand that my child(ren) will be under adult supervision and that in signing this permission slip I release and hold harmless Inland Lighthouse Church, its trustees, officers, employees, interns, and any volunteers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness (including but not limited to COVID-19) or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the activities.
I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached.
I understand that photographs and/or video recordings may be taken during church services, bus ministry activities, and church-related events. I give permission for my child(ren)’s image or likeness to be used by Inland Lighthouse Church for promotional, informational, or ministry purposes, including but not limited to social media, websites, printed materials, and other church publications.
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: