Child's Name:

  Date of Birth:

  Age:

  Mother's Name:

  Father Name:

  Address:

  Home Phone:

  Work Phone:

  Mother Cell Phone:

  Father Cell Phone:

  Email Address:

  Emergency Contact Name
(relative or friend):
 

 Emergency Contact Number:
 

My child needs transportation to school everyday: -select here- yes no     

My child needs transportation after school everyday: -select here- yes no     

My child needs transportation to and from school everyday: -select here- yes no     

I will need transportation for my child on a drop in basis and will call in advance for before or after school pickup:   -select here- yes no   (I understand that only children that ride everyday are guaranteed a ride.  Drop ins are only accepted if we have space.

WEE CARE has my permission to transport my child   to home and / or school.  I understand that in the event that there are other children riding at the same time, the driver will make the decision on who will be dropped off first.  Remember someone has to be first and someone has to be the last.  Our goal in the mornings is to make sure that everyone arrives at school in plenty of time for class.  No other promises can be made.
I understand that all precautions will be taken to ensure the safety and health of my child.  This is not intended as a waiver or release of any legal responsibility.

  Date:

  Name of Parent / Guardian:
(entering your name will serve as a verbal agreement that you accept the services, terms, policies and procedures of WEE CARE.  A written signature will be required once we meet in person)
 

******AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION******

In the event that we (parent's/guardian) cannot be reached at a time of illness or the emergency in such time that time does permit contact, I authorize WEE CARE representatives to obtain medical attention from a licensed physician and / or facility

Mrs. Sharron Jones
Acknowledgement

I have gone to "Policies and Procedures" on this website and read the Policies and Procedures and will discuss them with my child.  I have addressed any concerns that I may have concerning the Policies and Procedures of WEE CARE TRANSPORTATION (ONLY) and I agree to ABIDE by the rules outlined by the Program.

Children Enrolled In Camp:
1.   
2.   
3.   
4.   

Questions or Comments: