Westbrook Assisted Living & Memory Care Field Trip Permission Form October 2026

Westbrook Assisted Living & Memory Care Field Trip Permission Form

October 29, 2026, 3:20 - 4:30 pm
Student Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Primary Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Travel to the Nursing Home
I, the parent or legal guardian, give my permission for the above-named individual to be transported (via WyandotCARES van) driven by a WCC/HUB qualified staff/volunteer to the Westbrook Assisted Living & Memory Care on October 29, 2026.

I understand that all applicable laws regarding riding in a motor vehicle and directions provided by the driver and/or other adult volunteers must be followed.

I release Wyandot Community Connections, Inc (WCC) with all representatives, from any and all claims resulting from injury or damage that may be sustained by my child while participating in travel to and from the Westbrook Assisted Living & Memory Care and The HUB (a program of Wyandot Community Connections).
Parent/Legal Guardian Signature
Should be Empty: