Transportation Waiver

Transportation Waiver

Please complete this form to provide consent for transportation in a motorized vehicle. Read the waiver below and fill in all required fields.
WAIVER/RELEASE OF LIABILITY: The Funhouse Commons is committed to providing a safe, educational and enjoyable experience by taking the appropriate precautions to keep above-named student accident-free. Nonetheless, it is possible that even in the best of circumstances, accidents can happen. I agree to hold all sponsors, program coordinators, volunteers, and facilitators blameless from any liabilities participants may incur in connection with this program. Should I have any questions or concerns about these inherent risks, I will speak to a program coordinator and/or the facilitators before the program begins.

MEDICAL AUTHORIZATION: I certify that the above-named student has no medical or physical conditions that could interfere with their safety in participating in the program. I certify that I have disclosed any pertinent health concerns, medication information, or allergy information.

I authorize qualified emergency medical professionals to examine and in the event of injury or serious illness, administer emergency care to the above-named student. I understand every effort will be made to contact me to explain the nature of the problem prior to any involved treatment.

In the event it becomes necessary for the Funhouse to obtain emergency care for the above-named student, neither the Funhouse or staff-in-charge assumes financial responsibility for expenses incurred, including medical expenses, because of the accident, injury, illness, and/or unforeseen circumstances.
Participant Information
Participant's Full Name

First NameLast Name
Participant's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Consent and Acknowledgement
I have read and understand the Transportation Waiver and Release of Liability.
I give permission for my child to participate in transportation provided by the organization.
MEDIA RELEASE: I give my permission to have my youth’s image/voice (photo/video) used by event sponsors for grant reporting, educational and promotional purposes, including on social media. I understand that images/voices may be used in a presentation to help illustrate and explain the educational programs.
Signature of Parent/Guardian
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Transportation Waiver

Participant Information

Parent/Guardian Information

Consent and Acknowledgement