Request A Ride – Life Tabernacle

Are you requesting a ride on behalf of children under the ages of 18 that will be riding without a legal guardian?

Yes No

I acknowledge that I must be 18 years to ride without a legal guardian or that Life Tabernacle must obtain a signed consent (signature below) from a legal guadarian in order to obtain a ride.

First & Last Name (Dependent #1)

Relationship

Son Daughter Other (please explain)

If other relationship selected, please explain:

First & Last Name (Dependent #2)

Relationship

Son Daughter Other (please explain)

If other relationship selected, please explain:

First & Last Name (Dependent #3)

Relationship

Son Daughter Other (please explain)

If other relationship selected, please explain:

Do any of the above have allergic reactions to food?

Yes No

If so, please list allergies:

I hereby give my permission for all the children listed above to ride the Life Tabernacle Church van to attend Life Tabernacle services. I understand that my children will be under adult supervision. I further understand that in signing this permission slip, I release and hold harmless Life Tabernacle. By signing this permission slip, I release and hold harmless its trustees, officers, employees and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached.

Parent or Legal Guardian Signature

Life Tabernacle

2689 James Rd. Granville OH 43023

Sunday 12PM | Thursday 7PM