Bus Pickup Information Sheet
Please fill out this form completely to be picked up on the church bus by Lakeview Assembly of God 17930 Mahoning Ave Lake Milton, OH 44429.
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Email *
First Name *
Last Name *
Address *
Phone Number *
First Emergency Contact Name & Phone Number *
Second Emergency Contact Name & Phone Number *
Allergies (please all medical, food, etc.) *
Current Medications *
Any other health issues we would need to be aware of in case of emergency? *
Check One *
Name of parent/guardian completing the form *
Date of Form Completion *
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A copy of your responses will be emailed to the address you provided.
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