BBC Bus Rider Permission Form

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Child 1 Name
*

Child 1 Date of Birth
*

YYYY

Child 1 Grade

Child 2 Date of Birth

YYYY

Child 2 Grade

Child 3 Name

Child 3 Date of Birth

YYYY

Child 3 Grade

Pickup Address
*

Parent or Guardian 1 Phone #

Parent or Guardian 2 Phone #

Any special needs of child/children: (allergies to food, drink, etc). Please provide details if so. *

If child has allergies, do they have an EPI pen with them? *

Yes

No allergies

I have read, understand and agree to the Bethel Baptist Church Bus Ministry Rules.

I give consent for my child(ren) registered with the church to ride to and from Bethel Baptist Church services and church-sponsored events on Bethel Baptist’s buses. Further, I agree to hold the church, it’s officers, workers and volunteers guiltless in the event of an accident or injury to my child(ren).

I further grant permission for Bethel Baptist Church workers to act on my behalf in the event of an accident or injury to my child(ren) provided reasonable effort has been made to reach me. By signing below I affirm that my child(ren) can legally be transported on the bus in Indiana.

Please check both boxes.

I agree

Required

Adding your name below will serve as your signature.
*

Submit

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