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Respite care for children with higher needs

Consent and Waiver to Transport Child

I/We authorize Mentoring Matters staff to transport my minor child

I/We understand my child is expected to follow the directions provided by the driver and/or staff or volunteer. I/We have read, understand and discussed with my child:

1. My child will travel in a motor vehicle driven by an adult and my child will wear their safety belt during travel. 


2. My child is expected to listen to driver, respect staff and other children in the vehicles they ride in, and the people they travel with during the trip. 


3. Riding in a motor vehicle may result in personal injuries or death from accidents, collisions or acts by the riders, other drivers, or objects; and, 


4. My child are to remain in their seat and not be disruptive to the driver of the vehicle. 

I/We recognize participation in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss. I/We hereby attest and verify I/We have been advised of the potential risks, and I/We have full knowledge of the risks involved in this activity, and I/We assume any expenses incurred in the event of an accident, illness, or other incapacity, regardless of whether I/We have authorized such expense.

I/We release any claim on Mentoring Matters and their agents, officers, employees and volunteers from any claim that I could bring on my child's behalf with regard to any damage, demands or actions whatsoever, in any manner arising out of this transportation. I/We have read this entire waiver and authorization form, I/We fully understand its terms and conditions, and I agree to be legally bound by its terms.

Thanks for submitting!

Mentoring Matters, Where every moment matters

CONTACT US

For more information or if you have any inquiries, please do not hesitate to contact:

Green Lake, Portage, Waupaca, & Waushara Counties:

Matt Rohan (920) 250-0656

Outagamie, Shawano & Calumet Counties:

Sarah Funk (920) 422-4220

© 2025 by Mentoring Matters. All Rights Reserved.

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