Afterschool Bus Form 2016-17


bsd

BAYFIELD SCHOOL DISTRICT 10 JT-R
Permission and Agreement for After-School Transportation

Grade:

  (Student’s Full Name) has my permission to be transported after school on Wednesdays during the 2016-2017 school year between Bayfield School District (“BSD”) facilities to the Pine Church. I understand that BSD is not to be held liable / responsible for any accidents which may occur as a result of this transportation agreement.

BSD is expressly authorized by the Parents/Guardians and the Student to cancel or alter such transportation should conditions, at the sole discretion of BSD, require such cancellation or alteration. BSD shall not be required to notify Parents/Guardians and/or Students of such cancellation or alteration.

In case of a transportation emergency, BSD will make every reasonable effort to contact the Parents/Guardians and, if necessary, the Student’s physician, at (Phone Number). Should such contact not be possible, the Parent/Guardian hereby gives permission for emergency treatment to be given by the hospital to which the student is taken and by the treating physician whether or not such treatment occurs at the hospital.

The undersigned, for himself or herself, and for the above named Student hereby releases and agrees to hold harmless BSD and it’s School Board members, employees, agents, successors and assign, from any and all claims of whatsoever nature and kind which may arise from the participation of the Student in the transportation program described herein, including but not limited to any and all claims for injuries or damages to person or property, whether or not resulting from the negligence of BSD or its employees or agents.

In order to insure safe and comfortable transportation for all involved, students must adhere to the following rules and guidelines.

  1. Students must be at the pick-up bus stop at the appointed time each Wednesday. Bus drivers WILL NOT WAIT for individual Students who are tardy.
  2. Students may not ride the bus unless the driver has a list showing the Students name.
  3. All students shall adhere to all BSD Bus Regulations governing the transportation of students.
  4. All student discipline shall follow the guidelines as set forth in the Bus Rules / Regulations.

The undersigned Parent(s) / Guardian(s) understand the Bayfield School District is providing this transportation on a fee basis, and does not endorse the church or any religious group.

The undersigned Parent(s) / Guardian(s) and the student have read and understand the Bus Regulations and the above information.

 
Full Name of Responsible Parent or Guardian  /  Date

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Pine Valley Church http://pinevalleychurch.org
Signature Certificate
Document name: Afterschool Bus Form 2016-17
Unique Document ID: 8e10fa4255ff35343ab080e3dafe38f1a1042ffb
Timestamp Audit
2016-11-05 17:32:55 MDTAfterschool Bus Form 2016-17 Uploaded by Jill Shocklee - jill@pinevalleychurch.org IP 70.59.20.21