Bike Bus Program- Liability Waiver & Agreement

Email address *

Participant Name (Student) *

Student's Date of Birth *

Student's Grade *

Parent Guardian Name *

Phone Number *

Email *

Emergency Contact and Phone(if different than Parent) *

Where's my bus stop?

Which route will your child be on? *

Which Bus Stop will your child use? *

Ewing Street Gym

Campbell/Steele

Campbell/Capital

Capital/Todd

Campbell/Logan

The Kings Center

Capital/2nd Street

Bellepoint

Liberty Hall

Will your child be riding home in the afternoon Bike Bus? Children will be brought safely to their respective bus stops in the afternoons. Parents or guardians are responsible to meet children at their stop, or children must be able to navigate safely home on their own from their stop. *