1Northern New England District

PARENT/GUARDIAN PASSENGER WAIVER #1

Minor or High School Senior Driving Self Only

Adults are advised that Northern New England District’s Safety Policy recommends that youth
NOT drive themselves to district events (youth committee meetings, youth cons, and any other
district-sponsored youth events). It is the responsibility of the home congregation and/or parents of
said youth to provide safe transportation to and from district events, subject to the district youth
safety ratio of two adults per youth, one adult per two or more youth, or parents with own children.

The Northern New England District’s safety policy states that in the event that youth must drive
themselves to or from a district-sanctioned event, they must have a current license valid to
operate the vehicle to be driven, proof of insurance and the express written consent of their
parents. Upon arrival at the event, they must park their car until the end of the event and should
plan to get at least 8 hours of sleep the night before the event ends. Individuals may contact the
district office (603-228-8704) if special circumstances arise.

I, ____________________________________, hereby grant permission for my child,

(please print name of parent or guardian)
______________________________________, to drive to and from
(please print name of child)
_________________________________________________________,
(destination)
for the purpose of attending____________________________on________________
(name of district event) (date)
as I am unable to transport my child personally or locate another responsible adult to do so. By
signing this waiver, I assume full legal liability for my child.

Youth Driver’s License Number: _____________________ State ______________

Auto Insurance Carrier: _____________________________________________
Policy Number: _________________________________

I understand that neither the District staff, nor any adult advisor, nor NNED assumes legal liability
for the safety of my child/ward as my child/ward drives to and from the above-stated event. I
understand that the District staff, the advisors and the NNED are not responsible for determining
my child’s or ward’s fitness to drive. I hereby release them from and indemnify them against such
liability.

In the event of an emergency, I can be reached at the following numbers:

H_________________________W_______________________C _____________________

_____________________________________ ______________________________
PARENT/GUARDIAN SIGNATURE Date

Please provide the original of this form to the religious educator or adult youth coordinator in your congregation and a
copy to NNED at 10 Ferry St. #318, Concord, NH 03301 a week before the event. It can also be faxed to the district
office at 603-226-3011.

Rev. 3/16/10
 1Northern New England District
PARENT/GUARDIAN PASSENGER WAIVER #2
Minor Driver Transporting other Minors

Adults are advised that Northern New England District’s Safety Policy recommends that youth
NOT drive themselves to district events (youth committee meetings, youth cons, and any other
district-sponsored youth events). It is the responsibility of the home congregation and/or parents of
said youth to provide safe transportation to and from district events, subject to the district youth
safety ratio of two adults per youth, one adult per two or more youth, or parents with own children.

The Northern New England District’s safety policy states that in the event that youth choose to
drive themselves and other minors to or from a district-sponsored event, they must have a current
license valid to operate the vehicle to be driven, proof of insurance and the express written
consent of all parents involved. Upon arrival at the event, they must park their car until the end of
the event and should plan to get at least 8 hours sleep the night before the event ends.
Individuals may contact the district office (603-228-8704) if special circumstances arise.

I, __________________________________, hereby grant permission for my child,

(please print name of parent or guardian)
____________________________________, to drive _____________________________
(please print name of child) (please print passenger name)
to and from _______________________________________________________________
(destination)
for the purpose of attending _________________________________on______________
(name of district event) (date)
as I am unable to provide transportation personally or locate another responsible adult to do so.
By signing this waiver, I assume full legal liability for my child and her/his passenger(s).

Youth Driver’s License Number: _____________________ State ___________

Auto Insurance Carrier: ____________________________________________
Policy Number: _________________________________

I understand that neither the District staff, nor any adult advisor, nor NNED assumes legal liability
for the safety of my child/ward as my child/ward drives to and from the above stated event. I
understand that the District staff, the advisors and the NNED is not responsible for determining my
child’s or ward’s fitness to drive. I hereby release them from and indemnify them against such
liability.

In the event of an emergency, I can be reached at the following phone numbers:

H _______________________W____________________Cell ________________________

_________________________________ ________________________________
PARENT/GUARDIAN SIGNATURE Date

Please provide the original of this form to the religious educator or adult youth coordinator in your congregation and
send a copy to the district office at 10 Ferry St.#318, Concord, NH 03301 a week before the event. It can also be
faxed to the district office at 603-226-3011.

Rev. 3/16/10
 Northern New England District
PARENT/GUARDIAN PASSENGER WAIVER #3
Minors to Be Driven by Minors or by Adult Other than Parent

Adults are advised that Northern New England District’s Safety Policy recommends that youth
NOT drive themselves to district events (youth committee meetings, youth cons, and any other
district-sponsored youth events). It is the responsibility of the home congregation and/or parents of
said youth to provide safe transportation to and from district events, subject to the district youth
safety ratio of two adults per youth, one adult per two or more youth, or parents with own children.

The Northern New England District’s safety policy states that in the event that youth choose to
drive themselves and others to or from a district-sanctioned event, they must have a current
license valid to operate the vehicle to be driven, proof of insurance and the express written
consent of their parents. Except with written permissions, they must have no passengers. Upon
arrival at the event, they must park their car until the end of the event and should plan to get at
least 8 hours of sleep the night before the event ends. Individuals may contact the district office
(603-228-8704) if special circumstances arise.

I, __________________________________, hereby grant permission for my child,

(please print name of parent or guardian)
____________________________________, to be driven by the following minor or other
(please print name of child)
adult ___________________________________________
(please print driver’s name)
to and from __________________________________________________________
(destination)
for the purpose of attending ___________________________on_______________,
(name of district event) (date)
as I am unable to transport my child personally or locate another adult to do so. By signing this
waiver, I assume full legal liability for my child.

I understand that neither the District staff, nor any adult advisor, nor NNED assumes legal liability
for the safety of my child/ward as my child/ward is driven to and from the above-stated event. I
understand that the District staff, the advisors and the NNED are not responsible for determining
the fitness of participating youth or young adults to drive. I hereby release them from and
indemnify them against such liability.

In the event of an emergency, I can be reached at the following phone numbers:

H ____________________W_____________________Cell__________________

______________________________________________ __________________
PARENT/GUARDIAN SIGNATURE Date

Please provide the original of this form to the religious educator or adult youth coordinator in your congregation and
send a copy to the district office at 10 Ferry St. #318, Concord, NH 03301 a week before the event. It can also be
faxed to the district office at 603-226-3011.

Rev. 3/16/10