Cornerstone Apostolic Church
Van Permission Slip Form

______________________________________________________________has my permission to 
(Child's Name)

ride the church van to and from Cornerstone Apostolic Church.

I understand that Cornerstone Apostolic Church and their sanctioned members are not liable in case of accident. I understand that all precautions will be taken in order to provide a safe and worthwhile transportation.

In the event I cannot be reached to make arrangements for emergency medical care at the
time of illness or accident, I hereby authorize the van driver to take my child to the nearest hospital with emergency care.

*Please list any pertinent medical information that is vital in case of an emergency:




_______________________________________________________________________
Print name of parents/guardian

_______________________________________________________________________
Signature of parents/guardian

_______________________________________________________________________
Telephone number

______________________________________
Date
Cornerstone Apostolic Church~25 Beech Creek~Jamboree, KY~606.456.4400
www.cornerstoneapostolic.org