Permission to Transport & Emergency Form

I give permission for my child/charge (“child”) or children and/or myself to be transported in a motor vehicle driven by staff or volunteers of Student Advocacy Center. I understand that all applicable laws regarding riding in a motor vehicle and directions provided by the driver and/or other adult volunteers must be followed.

I have read and understand that:

  1. I and/or my child/ren will be traveling in a motor vehicle driven by an SAC staff or volunteer and we are to wear our safety belts (or be buckled into a car seat); while traveling.
  2. We are expected to respect each other, the vehicles we ride in, and the people we travel with during the trip;
  3. We are to remain in our seats and not be disruptive to the driver of the vehicle.
  4. Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; and
  5. We are not required to participate in SAC programming, but grant permission, despite the possible risks.
  6. I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, we may risk personal injury or permanent loss.

I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses.

Emergency Contact #1

Emergency Contact #2

Medical Information

Insurance Information

We need your insurance information in case of an emergency.

Parent/Guardian Signature

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