Request a ride. Your Name * First Name Last Name Your Email Address * Your Home Phone Number * (###) ### #### Your Street Address * Your Building/Apt/Unit Your City/Town * Glassboro How do you prefer to be contacted regarding your request for a ride? * Email Phone Call Text Message May Friends of Jesus send you text messages regarding your request for a ride? * Message and data rates may apply. You may opt out at any time by replying STOP. View our privacy policy at fojcs.org/privacy-policy Yes No Ride Purpose * Church Service Day Camp Medical Appointment Sunday Supper Vacation Bible School Emergency Contact 1 Name * (must be different than yourself) First Name Last Name Emergency Contact 1 Relationship * Emergency Contact 1 Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact 1 Phone * (###) ### #### Emergency Contact 2 Name * (must be different than yourself) First Name Last Name Emergency Contact 2 Relationship * Emergency Contact 2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact 2 Phone * (###) ### #### Comments or Special Instructions * Please check all that apply: * I will be riding as an Adult Participant (alone or with my children). My minor child(ren) will be riding accompanied by me (or another parent/legal guardian). My minor child(ren) will be riding unaccompanied by me (or another parent/legal guardian). Indemnity and Hold Harmless Statement and Parental Consent * Being the lawful parent/legal guardian of any minor child(ren) named below (hereinafter referred to as "Minor Participant(s)"), or participating solely as an adult ("Adult Participant"), I acknowledge and agree to the following in consideration for receiving a complimentary ride from Friends of Jesus Community Services, 105 Market Pl., Suite 9 Office 7, Glassboro, NJ 08028: 1. Definitions: *Participant(s): Refers collectively to myself, as the Adult Participant (if riding), and any Minor Participant(s) listed below, whether accompanied by me or riding without me but with my consent. 2. Assumption of Risk (Adult Participant): If I am riding as an Adult Participant, I understand that participating in a ride, even a complimentary one, inherently involves risks, including but not limited to, accidents, injuries, or property damage that may arise from various causes, including the negligence of the driver, other drivers, road conditions, or mechanical issues with the vehicle. I voluntarily assume all such risks for myself. 3. Assumption of Risk (Minor Participant(s)): I understand that participating in a ride, even a complimentary one, inherently involves risks for the Minor Participant(s), including but not limited to, accidents, injuries, or property damage that may arise from various causes, including the negligence of the driver, other drivers, road conditions, or mechanical issues with the vehicle. I acknowledge these risks for my minor child(ren). 4. Indemnification (Adult Participant Only): *This Clause Applies Only to Claims Made BY or ON BEHALF of the Adult Participant. I agree to indemnify, defend, and hold harmless Friends of Jesus Community Services, its officers, directors, employees, agents, and volunteers (collectively, the "Indemnified Parties") from and against any and all claims, demands, losses, liabilities, damages, costs, and expenses (including reasonable attorney's fees) that the Indemnified Parties may incur as a result of my participation in the complimentary ride as an Adult Participant. This indemnification applies to any injury, death, or property damage, however caused, arising from or related to the ride, regardless of whether such claims are based on negligence, breach of contract, or any other legal theory. 5. Hold Harmless (Adult Participant Only): *This Clause Applies Only to Claims Made BY or ON BEHALF of the Adult Participant. I further agree to release, waive, discharge, and covenant not to sue the Indemnified Parties for any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or any property belonging to me, whether caused by the negligence of the Indemnified Parties or otherwise, while participating in the complimentary ride as an Adult Participant. 6. Parental Consent for Minor Participant(s) (Whether Accompanied or Unaccompanied): I hereby grant my express permission for my minor child(ren) named above to participate in a complimentary ride provided by Friends of Jesus Community Services as requested above. I understand that my child(ren) may be accompanied by me or may be riding without me but with my prior consent, as indicated below. 7. Emergency Medical Consent (for All Participants, especially Minors): In the event of an emergency involving any Participant(s) during the ride, and if I or another parent/legal guardian cannot be immediately reached (for Minor Participants), I hereby grant permission for Friends of Jesus Community Services and its representatives to seek and consent to medical attention, including emergency transportation, examination, diagnosis, and treatment by a licensed medical professional, as deemed necessary for the health and safety of the Participant(s). I understand that Friends of Jesus Community Services assumes no financial responsibility for any medical expenses incurred, and I will be solely responsible for all medical costs for myself and my minor child(ren). 8. Contact Information: I agree to provide accurate and up-to-date emergency contact information for myself and my minor child(ren), and I understand the importance of being reachable in case of an emergency. 9. Binding Effect: This Statement shall be binding upon me, my minor children, and our respective heirs, executors, administrators, personal representatives, and assigns. 10. Governing Law: This Statement shall be governed by and construed in accordance with the laws of the State of New Jersey, without regard to its conflict of laws principles. 11. Severability: If any provision of this Statement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect. I have read this Indemnity and Hold Harmless Statement and Parental Consent carefully and understand its contents. I voluntarily sign it with full knowledge of its significance, confirming that I am the legal parent or guardian with the authority to grant this consent for my minor child(ren), and to bind myself as an Adult Participant. YES Parent/Legal Guardian/Adult Participant Signature * We have received your request! Note that submitting a request is not a confirmation that we will have transportation available on the days/times requested. We‘ll review your request and follow up with you as soon as we are able. Complete the information below to request a ride.
