Consent to Transport

I give permission for Iris Family Support Center staff to transport the individuals named below, as needed, for as long as we participate in programming at Iris Family Support Center.

I also agree to release Iris Family Support Center and its participating agencies and staff from any liability while transporting the individual named below.

Name of Individuals

When transporting children in car seats, only car seats provided by Iris Family Support Center may be used, unless the child has a medically required car seat prescribed by a professional.

Client Name

Client Signature Clear Signature

Date Signed

Client Name

Client Signature Clear Signature

Date Signed

Staff Name

Staff Signature Clear Signature

Date Signed