Church Van Permission Slip
This form is to be completely filled out and signed by parent or legal guardian before a child may ride
the van. Permission will remain active until revoked by parent or legal guardian.
Please print:
Parent or guardian name______________________________________________
Address___________________________________________________________
City________________________ State________________ Zip _____________
Home Phone ____________________________ Cell Phone _____________________
Other Phone ____________________E-mail address____________________________
Please list all children of your household who have your permission to attend Church, Church function
youth group, church related events, and/or its Van Program(s).
CHILD’S NAME
RELATIONSHIP TO YOU
First
Last
Son Daughter
Other
Age
DOB
______________________
__________
______
___________
______________________
__________
______
___________
______________________
__________
______
___________
______________________
__________
______
___________
______________________
__________
______
___________
Do any of the above have allergic reactions to any medications? Yes No
If so please list their names and the medications to which they are allergic:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
I hereby give my permission for all the children listed above to ride the van, participate in activities, and attend
Wheelwright Baptist Church or any of the church related functions. I understand that my children will be under adult
supervision. I further understand that in signing this permission slip, I release and hold harmless Wheelwright Baptist
Church and all other church-related functions. By signing this permission slip, I release and hold harmless its trustees,
officers, employees, interns, 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 ________________________________________ Date __________________
Please return this page to church
THINGS TO REMEMBER
In order to be sure that all children have a fun, safe and worthwhile day, we have a few things
to remember when riding the church van.
THINGS TO REMEMBER: During Transportation
1. Respect the driver.
2. Stay seated at all times and keep your arms and head inside the van. Don’t stand of the
seats.
3. Be nice to each other. Don’t fight for any reason.
4. Do not yell or scream at each other. Talk in a normal tone.
5. Do not drop or leave candy, gum or anything on the bus seats or floor.
6. Do not lie, cheat, steal or curse (this includes taking God’s name in vain). Remember, GOD
is watching you!
THINGS TO REMEMBER: Inside the Classroom
1. Respect your teacher/leader.
2. Do not fight, lie, cheat or steal.
3. Keep your classroom clean.
4. If you spill something, clean it up.
5. If you drop something, pick it up.
6. If you knock over chairs or disarrange them, put them back in place.
7. When you are dismissed, walk to the van instead of running.
THINGS TO REMEMBER: Inside the Church
1. Please walk instead of running and pushing.
2. Do not yell or scream at each other. Talk in a normal tone.
3. Do not fight, lie, cheat or steal.
4. Keep the hallways and bathrooms clean.
5. If you spill something, clean it up.
6. If you drop something, pick it up.
7. Leave any room better than you found it.
THINGS TO REMEMBER: At Home
1. Tell your parents what you have learned at church each visit.
2. Make your parents proud that you attend Wheelwright Baptist Church
3. Treat your family and friends the way you wish to be treated, the way Jesus Christ would
want you to. Remember, God is always watching!
Van Transportation RULES
In order to be sure that all children have a fun, safe and worthwhile day, we have a few rules
to follow for riding the van. They are as follows:
Eating or drinking on the van is not allowed.
Stay seated for the entire van ride facing front with feet on the floor.
Be courteous - name calling, inappropriate or foul language is not acceptable behavior.
Keep head, hands, and feet to yourself and inside the van at all times.
Talk quietly - yelling or screaming is unacceptable behaviors.
Do not throw any objects on the van, at the van or out of the van!
Hitting, punching or fighting is unacceptable behaviors. (Immediate two month
suspension!)
Destruction of van property will not be tolerated.
Cooperate with the van driver and helpers - follow their directions.
Follow the safe boarding and departing van procedures directed by the driver.
You are expected to RESPECT the van and each other!
If these rules are not followed one two week suspension will be given.
If the problem continues a one month suspension will be given.
Any offense after that will call for suspension for the year.
We hope you understand the importance of these rules and will help to support our church
discipline and safety policies.
All children, whether they ride the van or not, should come prepared for church.
In Christ,
Pastor David Boyd
If your child(ren) wants to be picked up for any church related activity, please call the church
and leave a message the day before the activity or church service. Your child(ren) will not be
picked up unless there is a message. We are doing this to make it easier to pick up everyone
that wants to come to church.
PLEASE CALL THE CHURCH AT 452-4770 or
MY CELLPHONE AT 791-0857