Contact Mission Church of Christ Van Consent Form & Liability Waiver

Contact Mission Church of Christ
Transportation and Activity Participation Waiver and Release Form

Please complete this form in its entirety to authorize your child(ren) to:

Ride on any Contact Mission Church of Christ (“Contact”) vehicles, and

Participate in any activities, events, or programs organized or sponsored by Contact.

Important Note:
Children under the age of six (6) must be accompanied by a parent or legal guardian in order to ride on Contact vehicles or participate in any Contact-sponsored activities.

By completing and submitting this form, you acknowledge and agree—on behalf of yourself and your child(ren)—to abide by all Contact guidelines and safety rules outlined below. Repeated failure to comply with these rules may result in the suspension or permanent revocation of transportation or activity privileges.

Contact Rules and Code of Conduct:

Follow Directions: All participants must listen to and follow instructions given by Contact staff members, adult leaders, or designated drivers.

Zero Tolerance for Violence: Physical violence or verbal aggression of any kind will not be tolerated.

Respectful Language: The use of foul, obscene, or inappropriate language is strictly prohibited.

Property Safety: Any child transported by a Contact vehicle must remain on Contact property until picked up or released with the direct consent of a parent or legal guardian.

Pick-Up/Drop-Off Policy: Children must be picked up and dropped off at the same designated location unless prior arrangements are made and confirmed by Contact staff.

Seat Belt Requirement: Seat belts must be worn at all times while riding in any Contact vehicle—no exceptions.

Parent or Guardian Info

Name

This address will receive a confirmation email

Phone

Address

Birthdate

Gender Male Female

If you have medical insurance, who is your provider?

Emergency Contact Information

Emergency Contact's Name

Emergency Contact's Phone Number

EC's Relationship to Children

Children's Information

Fill out separate info for each child

Child 1 Name

Child 1 Birthdate

Child 1 Gender

Male Female

Child 1 Allergies & Medications

Child 2

Scroll to bottom if no more children to register

Child 2 Name

Child 2 Birthdate

Child 2 Gender Male Female

Child 2 Allergies & Medications

Child 3

Scroll to bottom if no more children to register

Child 3 Name

Child 3 Birthdate

Child 3 Gender Male Female

Child 3 Allergies & Medications

Child 4

Scroll to bottom if no more children to register

Child 4 Name

Child 4 Birthdate

Child 4 Gender Male Female

Child 4 Allergies & Medications

Child 5

Scroll to bottom if no more children to register

Child 5 Name

Child 5 Birthdate

Child 5 Gender Male Female

Child 5 Allergies & Medications

Child 6+

If you have more children to register, please include their names, birthdays, gender, and any allergy or medical information here.

Additional Children

I hereby give my permission for all the children listed above to ride the van/bus, participate in activities, and attend Contact Mission Church of Christ or any of the church related functions. I understand that my children will be under adult supervision. I further understand that in signing this permission slip, I release and hold harmless Contact Mission Church of Christ and all other church-related functions. By signing this permission slip, I release and hold harmless its trustees, officers, employees, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached. I understand that my child(ren)’s photo may be taken and used in printed publications, website or social media by Contact Mission Church of Christ, and that I may contact the church office in writing to revoke this permission.

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Contact Mission Church of Christ Van Consent Form & Liability Waiver

Contact Rules and Code of Conduct:

Description

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