DGC Bus (Elnora / Lousana) Permission Form

Name (Required)

Email Address (Required)

#1. Youth who will be riding the bus: (Required)

Date of Birth Youth #1:

If you have more than one youth who will be riding the bus, please complete the following; if not, you may skip this section.

#2. Youth who will be riding the bus:

Date of Birth Youth #2:

#3. Youth who will be riding the bus:

Date of Birth Youth #3:

#4. Youth who will be riding the bus:

Date of Birth Youth #4:

Parent / Guardian info:

Your Phone Number

Emergency Contact

In the event of an emergency, who do we contact? Phone number?

Your Address

Location to be pick up and dropped off at:

Parent / Guardian Permission

Please check Yes/ No if you give permission for your child(ren) to walk home after being dropped off at the Community Centre.

By clicking Yes I/we, named above, undertake and agree to indemnify and hold the Pastors, the board of Deacons & Elders, the Ministry Staff, and any employees of DGC from and against any loss, damage or injury suffered by me/us as a result of being part of the activities of the DGC, as well as of any medical treatment authorized by the supervising individuals representing the church.

Todays Date: