Wyandot County Nursing Home Field Trip Permission Form December 2025

Wyandot County Skilled Nursing & Rehab Center Field Trip

December 16, 2025
HUB Kids 4 - 9 will go out and spread cheer to the residents of the Nursing Home on December 16, 2025. The van will leave The HUB around 3:00 pm and will return by 4:30 pm.

There will be a monthly trip beginning in January 2026, so please watch for signups for each month. New signups will be available for each month so that different students can attend as van space is limited.
Student Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Primary Parent/Guardian Phone Number*
Please enter a valid phone number.
I, the parent/guardian of the student named above, agree with the following statements:*

I hereby give permission for my child to take part in the trip listed above.I understand that my child is expected to behave responsibly and to follow The HUB's code of conduct and policies.I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child.
Travel to the Nursing Home

My child will be riding in the Van with HUB staff. (First come, first served as seats are limited.)I will be transporting my child to and from 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 Wyandot County Skilled Nursing & Rehab Center on December 16, 2025.

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) and WyandotCARES 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 Wyandot County Skilled Nursing & Rehab Center and The HUB (a program of Wyandot Community Connections).
Parent/Legal Guardian Signature*

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Wyandot County Skilled Nursing & Rehab Center Field Trip