Southwest Baptist Church - Transportation Form

Studen'ts First Name

Student's Last Name

Birthday

Parent/Gaurdians First Name

Parent/Gaurdians Last Name

Parent/Guardian Email

Address 1

Address 2

Country

City

State

Zip/Postal Code

Does your child have any food or medication allergies? If so please list name and allergy. If none, please type None or N/A

Does your child have any serious medical conditions we need to be aware of? If so please list name and condition. If none, please type None or N/A

By entering your name in the area below, you give consent to the person identified above to be transported by Southwest Baptist Church and will assume all liability for their participation in this or any activity/event and any injury that may result during the transport or at the event/activity. You also consent that you will not hold SWBC, 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 activity or travel. You also accept all financial responsibility for any personal items lost by the person(s) identified herein. You understand that disrespectful behavior and language and/or disregard for rules of safety by the person(s) to and from SWBC programs/events. And you accept full responsibility and hereby grant permission for the above named person(s) to travel with SWBC.

Parent/Guardian Name

Relationship to Child

Date

SWBC Church Transportation and Liability Waiver

You are welcome here!

Service Times

Contact Info

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