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Event Transportation Request

Black Men in White Coats Summit

February 1, 2025

Have you already registered your family for the "For the Family Rhythm and Resilience: The Doctor's Mixtape - Black Men in White Coats Summit"?
Yes
Any Child 13 and Over Riding Without Parent/Guardian?
Yes
No

Transportation Liability WaiverFor Shuttle Service to and from the Black History Month Event: "Rhythm and Resilience: The Doctor’s Mixtape"February 1, 2025


Location of Pick-Up and Drop-Off:First Institutional Baptist Church (FIBC)1141 E Jefferson St, Phoenix, AZ 85034


General Waiver and Release of Liability

By signing this waiver, I, the undersigned participant or parent/guardian, acknowledge and agree to the following terms regarding transportation to and from the event hosted by the Academic Medicine Consortium of Arizona and Black Men in White Coats on February 1, 2025:

  1. Voluntary Participation:I understand that utilizing the shuttle service is voluntary and provided as a courtesy.

  2. Assumption of Risk:I acknowledge that transportation involves inherent risks, including but not limited to accidents, delays, or other unforeseen events. I accept all associated risks and release BASE Arizona, Afro Scouts, First Institutional Baptist Church, and event organizers from any liability for injuries, damages, or losses that may occur during transportation.

  3. Chaperones and Supervision:Chaperones with Level 1 Fingerprint Clearance Cards will be present on the shuttle and at the event to ensure the safety and supervision of unaccompanied minors.

  4. Medical Emergencies:In the event of a medical emergency, I authorize chaperones or event staff to seek appropriate medical attention for my child or me and release them from liability for any decisions made in good faith during such an emergency.

  5. Damages:I accept responsibility for any damages caused by me or my child during the use of the shuttle.


Acknowledgment and Signature

By signing below, I confirm that I have read and understood this waiver. I accept the terms and conditions outlined herein.

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