Name of Parent Picking Up or Dropping Off *

First Name

Last Name

By checking this box you understand that you are responsible for all costs associated with picking up or dropping off your child at Mission Jax (Chets Creek, Hodges Campus). You also understand that you MAY NOT be able to pick them up at the EXACT TIME requested. We will try to accommodate as much as possible but we will have to use allotted free times in our daily schedule. *

I understand that I must be flexible in the time that I need to drop off or pick up my student and that I am responsible for all travel costs and travel liability associated with this request.

Yes, I agree

Name of Student *

First Name

Last Name

Parent Cell-Phone *

(###)

###

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Student Cell Phone *

(###)

###

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I understand that if my high school student is given permission to drive to or from Mission Jax that they must relinquish their car keys while on campus at Mission Jax and that only students who arrived with them in their vehicle can ride home with them in their vehicle. No other "new" students can ride in a student's vehicle. I also understand that I am liable for any student traveling in my child's vehicle and that Chets Creek Church is not responsible for any travel liability in case an accident or other event occurs during travel. I also understand that the other student's MUST HAVE PARENTAL PERMISSION & THE CHETS STAFF MUST KNOW THEY ARE ALSO RIDING with my student. *

Yes, I Understand