Bus Booking Form (One-off use) 1. This form is for those who are using the bus on a one-off basis. 2. In the event of a child not arriving to the meet-up spot, we will endeavour to find the child and/or inform the parents that their child has not arrived and they will have to come and collect him/her. Fathers Name First Name Last Name Father's Work Phone Area Code Phone Number Father's Mobile Area Code Phone Number Mother's Name First Name Last Name Mother's Work Phone Area Code Phone Number Mother's Mobile Area Code Phone Number Contact Email Child 1 name First Name Last Name Child 1 School Child 1 Grade 2024 Child 1 Medical Conditions Child 1 Drug or Food Allergies Child 1 Ongoing Medications Child 2 First Name Last Name Child 2 school Child 2 Grade 2024 Child 2 Medical Conditions Child 2 Drug or Food Allergies Child 2 Ongoing Medications Emergency contact (other than parents) First Name Last Name Home Phone Area Code Phone Number Mobile Area Code Phone Number Relationship I hereby authorise L’Chaim Chabad- Kingston & MHC leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I hereby authorise L’Chaim Chabad Kingston & MHC to transport my child from school to the centre by bus or similar. I accept that the centre has the right to refuse entry to my child on the bus (in case of ill behaviour or if they are unwell) and forfeit the remaining fees. I agree to the above declaration. Full Name* First Name Last Name DATE Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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