BOM CHURCH VAN RIDE REQUEST

*I, give my consent for me and the person(s) identified above to be transported by Bible Outreach Ministries Church of God In Christ (BOM) and will assume all liability for my participation in this activity/event and any injury that may result during the transport or at the event/activity. Further, by signing below.

*I will not hold Bible Outreach Ministries Church of God In Christ (BOM), its officers, agents, employees or anyone acting on its behalf, responsible or liable for injury occurring to myself any all the named persons I listed in the course of such activities or such travel.

*I understand that disrespectful behavior and language and/or disregard for rules of safety by myself and anyone I listed above while riding the BOM van will require that I find alternative transportation for said person(s) to and from the BOM program/event.

*I hereby accept financial responsibility for any personal items lost by the person(s) identified herein.

*I understand if I no longer desire to ride the van I need to contact the van ministries at least 24 hours before the departure time. If I do not, my privilege of riding the van may be impacted. I also agree to give a donation of $10 before submitting another form to ride the van again to help cover the inconvenience I may have caused by being a no show.

*I give BOM the right to contact my emergency contacts if they deemed an emergency has arise.

*I understand submitting this form does not guarantee I will have a seat on the van. I must contact Elder Mack 24 hours after this form is submitted to see if my seat is reserved.

*I also give BOM permission to text me on the mobile number I have provided on this form.

*I understand by signing below I accept all the terms and conditions of this form.