Sardis Missionary Baptist Church 2017 General Bus and
Sardis Missionary Baptist Church 2017 General Bus and Van Permission Form for Minors Dear Parent or Custodian: With your permission, the Bus Ministry of Sardis Missionary Baptist Church would like to provide transportation for you and your child(ren) to church-sponsored activities. The Bus Ministry of Sardis Missionary Baptist Church exists in order to help the Church fulfill its purpose of evangelism and discipleship by providing transportation to/from church and church sponsored activities for those who have no transportation. Parent/Custodian Statement I give consent for my child(ren) named below to ride to and from Sardis Missionary Baptist Church services and to and from church-sponsored events on Sardis Missionary Baptist Church buses or buses leased to Sardis Missionary Baptist Church. Further, I agree to hold the Sardis Missionary Baptist Church, its officers, workers or representatives guiltless in the event of accident or injury to my child(ren). I further grant permission for Sardis Missionary Baptist Church workers to act on my behalf in the event of accident or injury to my child(ren) provided reasonable effort has been made to reach me. By signing below, I affirm that my child(ren) can legally be transported on a bus in Alabama. Specifically, each child listed is at least 48 months old (4 years) and weighs at least 40 pounds. Names of Minor (Under age 18): 1. 2. 3. 4.
Name: ______________________ Date of Birth: ___________ Grade in School:_____________ Name: ______________________ Date of Birth: ___________ Grade in School:_____________ Name: ______________________ Date of Birth: ___________ Grade in School:_____________ Name: ______________________ Date of Birth: ___________ Grade in School:_____________
Address _________________________________________________________Zip Code____________ Phone # ____________________________________________________________________________ Emergency Phone # ___________________________________________________________________ Parent/Custodian’s Name (Please print) _________________________________________________ Parent/Custodian’s Signature__________________________________________________________
This form is valid for one year from date of parent/custodian’s signature. Rev. January 15, 2017
SARDIS MISSIONARY BAPTIST CHURCH, 1615 4TH COURT W, BIRMINGHAM, AL 35208 205-786-4376
Name: ______________________ Date of Birth: ___________ Grade in School:_____________ Name: ______________________ Date of Birth: ___________ Grade in School:_____________ Name: ______________________ Date of Birth: ___________ Grade in School:_____________ Name: ______________________ Date of Birth: ___________ Grade in School:_____________
Address _________________________________________________________Zip Code____________ Phone # ____________________________________________________________________________ Emergency Phone # ___________________________________________________________________ Parent/Custodian’s Name (Please print) _________________________________________________ Parent/Custodian’s Signature__________________________________________________________
This form is valid for one year from date of parent/custodian’s signature. Rev. January 15, 2017
SARDIS MISSIONARY BAPTIST CHURCH, 1615 4TH COURT W, BIRMINGHAM, AL 35208 205-786-4376
