Location Date

Name of Student Parent Signature

1_______________________________ ____________________________

2_______________________________ ____________________________

3_______________________________ ____________________________

4_______________________________ ____________________________

5_______________________________ ____________________________

6_______________________________ ____________________________

7_______________________________ ____________________________

8_______________________________ ____________________________

9_______________________________ ____________________________

10______________________________ ____________________________

By signing the above form, we, the parents understand that if we choose to remove our son/daughter from the bus, the Wilbur Creston School Districts and the school personnel (chaperones, teachers, coaches, and drivers) in charge of the trip are absolved of further responsibility concerning the transportation of your son/daughter back to the starting point of the trip.