WHC – Parental Consent to Ride the Bus

Child's Name: *

First

Last

Child's allergies or medical conditions:

Please list any allergies or medical conditions we need to be aware of, particularly in a medical emergency.

I have read and understood: *

I give permission for my child to ride on the World Harvest Church bus to attend WHC services and activities.

Please check.

I have read and understood: *

I acknowledge that weekly communication with the WHC Bus Ministry leaders about riding the WHC bus is necessary. I hereby consent to my child’s participation in such communication.

Please check.

I have read and understood: *

In the case of an emergency affecting the health or welfare of my child named above, the counselors, leaders, or adult chaperones have permission to administer first aid and or transport my child to the nearest doctor or hospital for further emergency medical attention as deemed necessary. The individual acting in response to the emergency, World Harvest Church, and its representatives will be held blameless.

Please check.

I have read and understood: *

I hereby grant permission for my child to receive emergency medical treatment, to be hospitalized, and to receive such injections, anesthesia, or operation as may be urgently necessary.

Please check.

I have read and understood: *

In an emergency, I understand that I will be notified of the situation as soon as practicable. I agree to pay any necessary expenses incurred in my child’s medical treatment, including, but not limited to, all transportation costs to and from a medical facility and, if necessary, transportation to my home or medical facility of choice.

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I certify that: *

I’m the parent or legal guardian of the child listed above. I certify that I have read this document, fully understand its content, and agree to its terms.

Please check.

Parent's Name: *

First

Last

Parent's Email: *

Parent's Phone: *

Date *

Parents's Signature: *