Evergreen Christian Community Church Consent to Transport Waiver and Release Form

Person(s) to be transported (One household per form)

First, Last Name(required)

First, Last Name

Street Address(required)

City, State, Zip Code(required)

Email Address(required)

Cell Phone Number(required)

Home Phone Number

Work Phone Number

Parent/Guardian Name(required)

I, the undersigned, give my consent for the person(s) identified above to be transported by EC3 designated driver(s) and will assume all liability for their participation in this activity/event and any injury that may result during the transport or at the event/activity.Further, by signing below: 1. I will not hold Evergreen Christian Community Church (EC3), its officers, agents, employees, assigns or anyone acting on its behalf, responsible or liable for injury occurring to the named person(s) in the course of such activities or such travel. 2. I hereby accept financial responsibility for any personal items lost by the person(s) identified herein. 3. I also understand that disrespectful behavior and language and/or disregard for rules of safety by the person(s) listed above while riding in the designated vehicle will require that I find alternative transportation for said person(s) to and from the program/event. Your name typed below will serve as your signature. (First, Last Name)(required)

Date(required)

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