Bus Permission Slip

Basic Information

Name

Age

Birthday

Gender

Female Male

Allergies

Special Needs

School

Guardian Information

Name

Home Phone

Cell Phone

Address

This address will receive a confirmation email

Relationship to Child

Emergency Contact Information

Different than Guardian Information

Name

Relation

Home Phone

Cell Phone

Guardian Permission

I give permission for my child to be transported by bus by Kids Central Ministry Staff.

Electronic Guardian Signature

Date

Description

Sunday morning pick up will be from 9:15-10:00. Please fill out this form and click submit.