Girl Scouts of Oregon and Southwest WashingtonPRIVATE

MOUNTAINDALE NORTH CAR SEAT PERMISSION FORM

This form specifies parents/guardians wishes for how troop members can be transported in other peoples cars. New Oregon Seat Belt Law Effective July 1, 2007
Infants must ride rear-facing until they reach both one year of age AND twenty pounds. Children who weigh over 40 pounds must be properly secured in a booster seat until they are age 8 OR 4'9" in height. Children who are age 8 or older OR are taller than 4'9" must ride properly secured with the safety belt system. Children over one year old and between 20 and 40 pounds must be properly secured with a forward-facing child safety seat up to a minimum of 40 pounds or the weight limit of the seat.

For more information, see the ACTS website, www.actsoregon.org My daughter _____________________________ can ride in other peoples cars for Girl Scoutrelated outings under the following conditions: ______My child weighs 40 pounds or less is under age 8 or under 49 tall, and must be transported in a forward facing child safety seat at all times. I will provide the seat. If a child is over 40 pounds, ONE of the following must be checked. If neither of the following is checked, then the child must have a belt-positioning forward facing child safety seat when travelling on Girl Scout outings. . ________My child weighs over 40 pounds AND is older than 8 years old or over 49 tall. She has my permission to ride in a car without use of a booster seat. _______ My child weighs over 40 pounds but I require that she must still ride in a belt positioning booster seat when transported by other drivers to Girl Scout functions. I will provide that seat for each outing. _______My child may ride in the front seat of a car (with or without a booster seat, as specified above) if there is no passenger-side airbag, or if it is disabled. I affirm that I have authority to specify the conditions under which my child can be transported to/from Girl Scout functions by others. This form is in effect unless updated in writing. Signed:

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_____________________________________________ _________ Print name/ relationship

_______________________________________ sign name date

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