Transportation Permission Waiver

							                              Transportation Permission Waiver
                                    for 4-H Ambassador

This permission waiver must be signed when a 4-H’er is riding with a fellow 4-H’er or driving to
a 4-H function in the role of a 4-H Ambassador. This form should be with the 4-H’er in the
vehicle at all times.

4-H’ers Name______________________________________________________________

Address___________________________________________________________________

County____________________________________________________________________

Name of driver if not self______________________________________________________

County of driver if not self______________________________________________________

Automobile Make_________ Model___________ Color___________                 Tag_____________


To be completed by driver’s parent/guardian
I give my permission for my child,___________________________to provide transportation for
himself/herself and the following 4-H’ers:

I understand that my child will be picking up these 4-H’ers at various locations and is expected
to arrive at_________________________for a 4-H Ambassador function. My child has a valid
driver’s license and auto liability insurance.


Signature of Parent/Guardian___________________________________________________



To be completed by passenger’s parent/guardian
I give my permission for my child,________________________to ride in the above listed
vehicle driven by ___________________________________, a 4-H’er.

I understand the 4-H’er driving will provide transportation for a 4-H Ambassador function.

Signature of Parent/Guardian____________________________________________________




                                                                                             JJ 8/98