Youth Transit Permission Form

Youth Transit Permission Form
Participant Name*

First NameLast Name
Date of Trip: March 2024 – June 2024

Location of Trip: KDHS – The Bridge Youth Resource Center

Method of Transportation: SECC Transit

Number of SECC Staff/Supervisors: 1

Departure Time: 2:45 PM

Return: Participants need a ride home from program

Cost per Participant: $0.00
Parent/Guardian Contact Information
Parent/ Guardian Full Name*

First NameLast Name
Parent/ Guardian Signature*

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Date*

MonthDayYear
Date
As parent/guardian of First Name* Last Name*, I have read and understand the above in formation. By signing I give permission for my son/daughter to participate in this activity/field trip.
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Contact Telephone Number*

Area CodePhone Number
Child's Medical Condition (if any)
Should be Empty: