GO GERONIMO's

Parental Consent Form for Minors

San Geronimo Valley Healthy Start

488-8888

GO GERONIMO RIDE REGISTRY

PARENTAL CONSENT FORM FOR MINORS

My child (print full name) ___________________ has my permission to register for the GO GERONIMO Ride Registry as a rider. I understand that my child will fully complete the registration process, learn the rules of the program, and be issued a photo ID before he or she engages in this flexible registered ridesharing program. I also understand that there is no guarantee of the timeliness of receiving rides, and that GO GERONIMO does not endorse ridesharing between non-members of the program nor pick-ups or drop-offs anywhere except at the designated GO GERONIMO Reg stops. I have read and signed the Healthy Start Transportation Program Release Form and understand that all liability in these rideshares rests with the driver and his or her insurance, just as it does anytime people receive rides from family, friends and neighbors.

Signed: ____________________________________

Date:______________________________________

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