RETURN BUS RIDER INFORMATION SHEET

Please fill out this form and click submit.

NOTE: Please submit request by Friday at 12:00 noon for the upcoming Sunday Church Services.

Date

*

Name

*

Address

*

Phone

*

Number Of Adults Needing A Ride

Please select one option.

1 2 3 4 5 6 7 8 9 10

Number Of Children Needing A Ride

Please select one option.

1 2 3 4 5 6 7 8 9 10

* Children under 6 years must be accompanied by a parent, or guardian.
* Children under 18 years riding without parent, or guardian will need to have a completed permission & Emergency Contact Information Form.
* This must be signed by parent, or guardian prior to riding on bus.

Do you need assistance with a wheelchair, or walker?

*

Please select all that apply.

yes no

I give Mt Olive Baptist Church of Greenwood authorization to call 911 and or ambulance transportation to the nearest hospital in the event of an emergency.

*

Please select one option.

Yes No

By completing this form electronically, and clicking "Submit," you aknowledge that you have read and agree to Mt. Olive Baptist Church Bus Riding Policy & Procedures. You also confirm that all information provided is accurate, correct, and true.

Description

Please fill out this form and click submit.

Please Fix the Following

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