MBUSD- Walking School Bus Permission Slips
Please read through the following forms and electronically sign both your name (parent) and your son/daughter's name.
1. A parent must be presnt at the pre-determined "bus stop" to "hand-off" their child to the WSB Volunteer ("driver").
2. If a child is unable to participate on a day they are scheduled (e.g., vacation, illness) contact the designated WSB Leader ("driver") as early as possible.
3. Children and their parents must arrive on time at the pre-determined "bus stop" drop off locations. If a child misses the bus, the parent is responsible for getting them to school.
4. Parents who have a child with special needs, health conditions or specific requests should contact their school's Walking School Bus Coordinator.
5. Safety for all parties involved is of utmost importance in our program. Parents should review the student expectations (located below) with their child before they walk with the bus.
I understand and agree to the roles, responsibilities and liabilities of a parent with a child in the Walking School Bus program as defined under the school district's policies and procedures. Participants may be photographed and such photographs may be used to publicize city programs/activities.
Electronically Sign below, confirming that you have read and understand the above expectations.
Parent Phone Number
Please review the following rules and expectations with your child(ren).
WSB SAFETY RULES
1. There will be one volunteer walking in front of children and one behind.
2. Children are to stop one sidewalk block away from street when getting ready to cross.
3. Children must hold a friends hand when crossing the street and all children will cross together.
4. Children should always stay within crosswalk lines when crossing the street.
5. Volunteers call out look left and then look right when crossing the street.
6. Running is not permitted, but children may skip to school.
7. Volunteers will remind children to be aware of traffic at drive-ways and intersections.
8. Volunteers will wear reflective vests for easy visibility.
9. WSB participants will be respectful of other students, the WSB Leaders and the neighborhood.
10. If participants do not follow the WSB Safety Rules, the Volunteer will give one verbal warning and if the behavior persists they will complete an incident report form at school. The school will follow up with the parent and student based on their existing protocol.
I have reviewed and understand the role and responsibilities of a Walking School Bus Participant with my parent(s) and agree to follow all these rules.
Electronically Sign (student name) below, confirming that your child has read and understands the above expectations.
MBUSD- Permission Slip Signature
Parent Permission for Student Participation in Off-Campus School-Sponsored Activity
[Print student's full name below] has my permission to participate in [Print name of school below] Walking School Bus. He/she will participate on the following days of the week [List days of the week below].
1. I understand that all students going on this trip will be responsible in conduct to the bus driver, to teachers or sponsors. It is further understood that students will go and return from the event on the transportation provided and that every reasonable precaution will be maintained on the trip.
2. I hereby acknowledge that I have been advised that the activities involved in this excursion/field trip or event are not considered by the district to be of "hight risk" to the participants.
3. Students are responsible to make up any assignments missed due to this school-sponsored field trip.
I, the undersigned, parent or legal guardian of the above named student, consent in advance to whatever medical treatment or procedures might be necessary for my son/daughter in case of injury or illness during the trip. Such treatment may include, but is not limited to, anesthesia, X-ray examination and medical or surgical diagnostic procedure, and shall be in the best judgement of the attending physician. I understand that every reasonable effort will be made to reach me in case of serious illness or injury.
In the boxes below, please electronically sign your name (parent) and your child(ren) names to confirm that you have agreed to all of the above expectations and terms.
Please select the school that your child attends.
Grand View Elementary
Specify what grade your child(ren) is in.
Choose the MB "bus" route you will be joining:
Pacific Route 1: 27th St/Walnut Ave @ 745a
Pacific Route 2 (AM Kinder): 17th /Oak Ave @7:45a
Pacific Route 3 (PM Kinder): 17th/Oak Ave @ 11:15am
Days of the Week
Specify what days of the week your child(ren) walk or intend to walk to school.
List name, phone number and their relationship to the student.
Medical Insurance Carrier
In case of an emergency, please list your carrier (e.g. Blue Cross, Kaiser)
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