Offsite Transportation Form
As a parent/ guardian, I give permission for my child to participate in the programs and activities of Cornerstone youth Center.
In addition, I give permission for Cornerstone staff to transport my child by Cornerstone van:
To: Pine Grove Furnace - 1100 Pine Grove Road, Gardners, PA 17324.
On: Wednesday, June 24th from 9:00 a.m. - 5:00 p.m.
If you have any questions of concerns, please contact:
Jonathan Weatherholtz at 717-723-1580 or jonathan@cornerstoneetown.org
I am aware of the inherent risks associated with these activities and that all risks cannot be prevented. If my child should require emergency medical treatment, I consent to such treatment. I acknowledge that Cornerstone does not provide accident or health insurance for youth participants, and I agree to be responsible for any medical bills incurred as a result of emergency medical treatment.
To the maximum extent permitted by law, I hereby hold harmless and release Cornerstone, its employees and volunteers, from any claims for damages or injury to my child or property, which may arise from my child’s participation in the above program and all related activities.
