Parents/guardians: Complete and submit this form to indicate your interest in having your child(ren) participate in a Walking School Bus route. Please note, submission of the form does not guarantee enrollment in the program. Register your student(s) today! Name of Student Grade Infinite Campus ID Student Homeroom Teacher Do you have more students to register? Yes No Name of Student Grade Infinite Campus ID Student Homeroom Teacher Do you have more students to register? Yes No Name of Student Grade Infinite Campus ID Student Homeroom Teacher Do you have more students to register? Yes No Please list name, grade, Infinite Campus ID and homeroom teacher of additional children Please list any special conditions and/or allergies Name of Parent/Guardian Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Code Primary Contact Number Secondary Contact Number Email Address I agree to the terms of service. Terms and Conditions I give permission for my child(ren) to participate in the Walking School Bus program and to be photographed for promotional purposes. I will not hold staff, administrators, or volunteers at Racine Unified School District and United Way of Racine County responsible for accidents or injuries involving my child(ren). I understand that routes will be scheduled based on Route Leader availability and location of other WSB participants. I acknowledge that my student will not be walked home. By signing this form, I understand that my child is not guaranteed to be on a route, but will be considered during route planning. Signature Reset Date Submit Leave this field blank
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