Optional permission/waiver regarding transportation of children in vehicles

I,________________________, hereby authorize ________________________ to be transported by ________________________ in a motor vehicle for the following purpose(s)

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I have read the material of this document regarding automobile insurance coverage and (check one of the following):

_____ I am satisfied based on my own review that the Child Care Provider or other person I have authorized to transport my child has adequate automobile insurance coverage and that the provisions of the automobile insurance policy specifically cover injuries and deaths arising out of an automobile accident occurring during the course of conducting a child care business.

_____ I specifically agree to hold the Child Care Provider (or other person I have authorized to transport my child) harmless from any claim or suit at law based on a death or injury to my child caused by the negligence of the Child Care Provider or authorized driver during the course of transporting my child by motor vehicle as authorized above to the extent that such loss is not otherwise covered by the terms of the Child Care Provider’s or authorized driver’s automobile insurance policy.

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(Date)_________________________________ (Signature of parent/guardian)