RBUSD- 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 present 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 Name

Please review the following rules and expectations with your child(ren).

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.

Student Name

Student Participation in District- Sponsored Voluntary Activity
Parental Permission, Assumption of Risk, and Medical Treatment Authorization

[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].


In the event of illness or injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care and emergency transportation considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.

I fully understand that participants are to abide by all rules and regulations governing conduct during the trip.

I agree to waive all claims against the RBUSD and hold the district, its officers, agents, employees and volunteers harmless from any and all liability and claims, which may arise out of or in connections with my child's participation in this activity.

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.

Parent Name

Please choose the school that your child attends.

Specify what grade your child(ren) is in.

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.

In case of an emergency, please list your carrier (e.g. Blue Cross, Kaiser)

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