Bus/Van Rider Form

Date

Bus/Van rider Name

Parent or Legal guardian Name:

Address

Phone

This address will receive a confirmation email

Please list all children in your household who have permission to attend East Side Baptist Church on the bus or van. Give First and Last name, Age, and Date of Birth

Do any of the above have allergic reactions that we need to be aware of?

Yes No

If so, please list their name and what they are allergic to:

What day of the week do you need a ride on the bus?

Wednesday Sunday Wednesday & Sunday

I hereby give my permission for all the children listed above to ride East Side Baptist Church's bus/van. I understand that my children will be under adult supervision. I further understand that in signing this permission slip, I release and hold harmless East Side Baptist Church, it's trustees, officers, employees, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergncy medical assistane if I cannot be reached.

Name:

Date:

Description

Please fill out this form and click submit.

Bus/Van Rider Form

Description

Please Fix the Following