Pickle Bus Registration 2019-2020

Complete this for each student riding the Pickle Bus for the 2019-2020 school year.
Parent/Guardian Information

 
 
Phone numbers including area code.
xxx-xxx-xxxx
 
 
Student Information

 
Please select one option.
 
Please select one option.
Please select all that apply.
 
Child/Youth Agreement

Child/Youth needs to check box agreeing with the following statement.
Please select one option.
Permission

Please select one option.
Please select one option.
Please select one option.
Medical Insurance

 
 
 
 
Please select one option.
 
 
Agreement to call for absences

Please select one option.
For office use only.

Please select all that apply.
Gloria Dei Lutheran Church respects your privacy.

Description

Complete this for each student riding the Pickle Bus for the 2019-2020 school year.