Mt. Olive Baptist Church Transportation Ministry

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NOTE: Please submit request by Friday at 12:00 noon for the upcoming Sunday Church Services.

* IF YOU HAVE PREVIOUSLY FILLED OUT THIS FORM REFER TO RETURNING RIDER FORM

Please select all that apply.

Type Of Event

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Sunday Worship Choir Rehearsal Church Special Event

Date

Name

Gender

Please select one option.

Male Female

Marital Status

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Married Single Widowed

Names of additional Riders

Address

Phone

Number Of Adults Needing A Ride

Please select one option.

1 2 3 4 5 6 7 8 9 10

Number Of Children Needing A Ride

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1 2 3 4 5 6 7 8 9 10

Do You Live In...

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House Apartment Other

Medical

Known Allergies

Medical Conditions ...example seizures, pace maker, diabetes etc ...

Emergency Contact

Emergency Contact Phone

* Children under 6 years must be accompanied by a parent /guardian.
* Children under 18 years riding without parent/guardian will need to have a completed permission & Emergency Contact Information Form.
* This must be signed by parent / guardian prior to riding on bus.

I give Mt Olive Baptist Church of Greenwood authorization to call 911 and or ambulance transportation to the nearest hospital in the event of an emergency.

Please select one option.

Yes No

Do you need assistance with a wheelchair or walker ?

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Yes No

By completing this form electronically, and clicking "Submit," you aknowledge that you have read and agree to Mt. Olive Baptist Church Bus Riding Policy & Procedures. You also confirm that all information provided is accurate, correct, and true.

Description

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Mt. Olive Baptist Church Transportation Ministry

Description

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