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____________________________________________________