Home - Heritage Baptist Church

Heritage Bus Rider Registration

ONLY to be completed by Parent or Legal Guardian

City

Registration filled out by- Parent/ Legal Guardian's Name

Parent/ Legal Guardian's Phone Number

Parent/ Legal Guardian's Email

Rider's Name

Grade

Address

Street Address

Apt or Trailer #

City

State

Zip Code

Food Allergies or Medical Conditions/Concerns

Emergency Contact's Name

Emergency Contact's Relationship to Rider

Emergency Contact's Phone Number

I acknowledge that by selecting this box, I am providing my electronic signature and agree to the following:

Medical Authorization: I permit Heritage Baptist Church to secure any necessary emergency medical or dental treatment for my child, including transport to a hospital, if reasonable attempts to contact me are unsuccessful. I accept full financial responsibility for all associated costs.
Media/Photography Release: I allow Heritage Baptist Church to use photos, videos, and livestreams in which my child may appear, for promotional or online purposes.
Consent & Liability Waiver: I grant permission for my child to participate in the Heritage Baptist Church Bus Program. I release Heritage Baptist Church, its officers, employees, and volunteers from all liability, including injury, loss, or damage resulting from participation. This agreement is legally binding and selecting this box is my voluntary consent.

Relationship to Rider

Date of Registration Completion