Parent/Guardian Consent Form

Please return this form to the acting coordinator:   Angela  D. Goldsmith

My child/children will be using the North Portland MLC Bike Bus.

He/she/they will join the bus at the following stop insert here

Child/children’s name:  insert here

Address: insert here

Phone number: insert here

Parent’s daytime phone:  insert here

Parent and/or child’s email:  insert here

Emergency Contact:  insert here

_ I realize that my child’s journey to and from school is my responsibility even though they will be using the bike school bus without my attendance.  If my child is late to the bus stop in the morning or the afternoon and misses the bus, I am responsible for getting him/her to/from school.

_ I have read the guidelines and explained the behavior expectations to my child.

_ I will notify the bus leader if there are any changes to my child’s bus schedule.

_ I understand  this is a volunteer endeavor  that has provided basic biking skill & group ride clinics  and resources for increasing children’s and parent’s biking skills, that my child is a confident and skillful rider and as such is comfortable riding in a group and in traffic.

_ I understand this bike bus has been initiated and organized around varying bike and walk to school organization programs,  but in no way is connected to these organizations,  nor is this affiliated with or the responsibility of Metropolitan Learning Center.

I insert name here , the undersigned, give my consent for insert child’s name here to participate in the bike school bus.  I hereby release the acting coordinator, and other parent participants acting as lead or sweep riders from any and all liability related to the bike bus endeavor.

Parent/Legal Guardian Signature                        Date

Published on October 21, 2008 at 7:42 pm  Leave a Comment  

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