Transportation Permission/Medical Information
Sign in to Google to save your progress. Learn more
Email *
I understand that by completing this form I give permission for my student to ride with any Kings Valley Charter School approved volunteer/driver to and/or from school events scheduled through the school.
Clear selection
Today's Date *
MM
/
DD
/
YYYY
Student Name *
Parent/Guardian Name *
Only in court proven cases of school staff negligence does school insurance provide coverage for injuries to students occurring while they are under school supervision. Medical expenses for other injuries or illness must be assumed by parents or by the parents' insurance.
Medical Insurance Information
If the school is unable to contact me, and it is deemed necessary, I give my permission for school personnel to secure emergency medical treatment for my son/daughter while on this trip.  I understand that I must assume the medical expenses that this might cause.
Insurance Company *
Policy Number *
Contact Information
Please provide a phone number where you can be reached in the event of an emergency.
Primary Phone Number *
Work Phone Number
Emergency Contact Information
In the event that you can not be reached, please contact the following people.
Contact Name *
Contact Phone Number *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Kings Valley Charter School. Report Abuse
Google Forms