2009-2010 Transportation Release Form

2009-2010 Transportation Release Form This form MUST be in the possession of any driver of minors. This form is required for EVERYONE UNDER 18 who is being transported by anyone other than a custodial parent or guardian. All persons transporting minors must be at least 21 years of age. Name of Youth: _________________________________________________________ Home address & Phone: __________________________________________________ Drivers Authorized by First Congregational Church of Santa Cruz have my permission to transport the above-named minor in relation to programs and activities of First Congregational Church of Santa Cruz. I further grant permission to the Drivers Authorized by First Congregational Church of Santa Cruz to act as my agent(s) while transporting my child, in authorizing any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by and is rendered under the general or special supervision of any physician and surgeon licensed under the provision of the Medicine Practice Act. (The above to occur only after reasonable efforts to contact the undersigned have been unsuccessful.) Comments, additional information: _________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. Parent or Guardian Signature: ______________________________________________ Parent or Guardian Printed Name: __________________________________________ Date: __________________ Phone numbers where custodial parent(s) / guardian(s) may be reached: Home: ________________________________________________________________ Work 1: _____________________________ Work 2: ___________________________ Cell 1: _______________________________ Cell 2: _____________________________