PERMISSION SLIP

I, hereby give consent for my child(ren), listed below, to ride the van to and from Corner Stone Baptist Church. I further understand that in signing this permission slip, I release Corner Stone Baptist Church fully and completely from all liability.

My permission for Corner Stone Baptist Church workers to act on my behalf is granted. This is in the event of an accident or injury to my child(ren) provided reasonable effort has been made to reach me directly.

Please List all that are attending—including the adults.

Child(ren’s) Name	Date of Birth For Ages 0 - 19	Current School Grade Mark “NA” If rider is not enrolled in school.

Parent/Custodian Name (Please Print or Type):

Parental/Custodian Signature and Date: _________________________ Date: ________

Phone Number (Please Print or Type):

By checking the agree box below, you are giving your child permission to ride the van to and from the church. The checked box also indicates that you have read the guidelines above; and, are in agreeable with them.

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