Name of Parent/Carer: "I give permission, due to special circumstances, for the leader(s) named below to provide transport to (name of activity) for (name of child) without another leader present in the vehicle." Names of leaders: I have been assured that the named leaders are fully qualified and insured to drive, have suitable safety equipment available and will transport my child in the rear seat. I have contact information for the named leaders in case of emergency. I will ensure that a responsible adult will be present at pick-up and drop-off times.