Van Rider Permission Slip
Please fill out the form below if your child is going to ride in the church van and attend activities at Three Rivers Bible Church. Children are not allowed to ride in the church van unless this form has been filled out.
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Child's full legal name *
Child's date of birth *
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Medical conditions to be aware of (If none, type "NA") *
In case of emergency, please list any medication/dosage, including OTC, the child currently takes (if none, type "NA") *
Please list any physical restrictions (if none, type "NA") *
If there is anything you do not  wish for your child to participate in, please list it here.
Date of last tetanus or booster?
Emergency Contact Name(s) *
Emergency Contact(s) Relationship to Child *
Telephone Number(s) for Emergency Contact(s) *
Address (including city, state, and zip) *
Our Purpose and Beliefs: We are a Bible church. We believe the Bible is God’s Word. As such, our purpose, as given in Matthew 28:19-20, is: To teach the Bible. After a person trusts Christ as their Savior, we teach that person how to have God’s blessings in life by obeying and living by the principles found in the Bible. To present the Gospel: We are sinners (Rom. 3:10); the price for sin is to die and spend eternity in hell (Romans 6:23); Jesus died to pay for our sin (Romans 5:8); Jesus will save anyone who will call on Jesus and trust Him to be saved (Romans 10:13).

I understand the purpose and beliefs of the Three Rivers Bible Church. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them above.

In the event an emergency occurs, I can be reached at the telephone number/s listed on this form. If I cannot be reached within a reasonable period of time, I hereby authorize the adult sponsor, Brian Wright/Debbie Wolthuis, to make emergency medical decisions for my child.

Understanding this, I give my permission for my child, to ride the van and to attend the Three Rivers Bible Church and be taught the Bible.

I understand and hereby agree to assume all of the risks which may be encountered on said activities, including preliminary and subsequent thereto. I do hereby agree to hold Three Rivers Bible Church and its leaders and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which my child now has or which may arise in the future in connection with the activity or participation in any other associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Michigan, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto, and the terms of this release are contractual and not mere recital. 

I am aware that this is a release of liability and a legally binding agreement. No oral representations, statements, or inducements apart from this agreement have been made to me. I understand this is a legally binding agreement. I further state that I have carefully read and fully understand its contents, and I sign this agreement of my own free will.

Parents/Guardians, please sign below by typing your full name.
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