Unaccompanied Minor Form - Central Oregon Breeze

Unaccompanied Minor Form
Central Oregon Breeze

For minors 5-13, fill out sections 1 and 2.
For minors 14-17, fill out sections 1 and 3.

Complete this form for all minors, Print a copy and hand to the driver upon boarding.

Section 1 - passenger names

Age _________Child's Name__________________________________________________

Section 2 - responsible adults

Pick-up person's name________________________________________

Contact phone number________________________

Note: Instruct your pick-up person to be early. Pick-ups more than 5 minutes late will be charge $10.00, and after 10 minutes, the drivers are instructed to leave. The child will remain on board.

Signature of person putting the child on board______________________________________

Date____________ Your phone number _______________ (preferably a cell phone)

Section 3 - release for children 14-17

I certify that my child may be left at the drop-off point without someone there to meet them.

Your signature ______________________________________

Date____________ Your phone number _______________

I want to keep this release active (check one) one-time only for a year

Print this form, and then return to the Home page or the Instructions for minors page.