Parental Consent

There is no such thing as being too cautious!

Empathy for your service, forever our concern!

For Parental consent forms are for the protection of all parties involved. All parents must complete each form prior to services being performed! All details shared will not be provided to any third parties and will only be used for the safety of the child and provide documentation in the event that the documentation is needed.

Contact Us

Service Type

If One-Time Service Date:

Contractual Services Agreement Dates

Parent's or Guardian Name:

Parent or Guardian Name: 2

Phone Number:

Secondary Contact Number:

Child's Name:

Child's Birthdate:

School, Facility, Employer Name:

Authorize Party to drop your child off with :

Authorize Party Phone Number:

Emergency Contact Name:

Emergency Contact Number:

In the event of a emergency while in the vehicle, we will go to the nearest Hospital. Please provide any recommendations:

Can our chauffeurs perform CPR or the Heimlich?

Please provide any medical conditions as it may pertain to your child and the transportation service received:

Would you like for this consent to apply to all future transportation services up to 1 year?:

Additional Information:

Completed By:

New Field:

Today's Date:

Time

Opt-In

I have read, agree to share my information & understand the Terms Service Ageement as it pertains to Eastern Shore Transportation Kid & Youth Transportation Services and understand that checking the box is a form of signature & that I am 18 or older.

Opt-In

By checking, you understand that in sharing this information, it will not be shared with third party sources and will only be used for your transportation service.