Consent and Promise

Consent and Promise

Please complete the form below to consent with the Cults Primary Walking Bus guidelines.
Name(s) of child(ren)*
Parent/Guardian's name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home phone number

Area CodePhone Number
Mobile phone number

Area CodePhone Number
Special medical needs of any of the above mentioned child(ren)
Person dropping off child(ren) if not you

First NameLast Name
Phone number of above adult (drop off alternative)

Area CodePhone Number
Alternative contact if child's parent / guardian cannot be contacted*

First NameLast Name
Phone Number of alternative contact*

Area CodePhone Number
Relationship to child*
Child Photo/Video Consent Form
We would be grateful if you can give us permission to take photos and/or videos of your child(ren) and use these in our printed and online publicity for the walking bus.
I give Cults Primary School Walking Bus permission to take photographs and videos of my child(ren)*

YesNo
I grant Cults Primary School Walking Bus full rights to use the images resulting from the photography/video filming for publicity and/or raising awareness of the walking bus purpose. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications.*

YesNo
Parent and Child's Promise
PARENT’S PROMISE

I PROMISE I HAVE:
- Talked to my child about road safety on the walking bus
- Made sure that my child understands how the bus operates
- Made sure that my child knows what is expected of him / her
- Made sure that my child understands that once they have arrived at the school grounds, they must remain on the school premises
- Made sure that my child knows to join their class line once the school bell rings
- Made sure that my child knows what days they are travelling
- Discussed with my child what to do if things go wrong e.g. He / she misses the bus
- Agree to contact the bus admin team if my details change
- Agree to join and use the dedicated WhatsApp group to allow for fast relay of essential information (e.g. weather related updates, unexpected school closure etc.)
I AM AWARE THAT I AM RESPONSIBLE FOR MY CHILD'S JOURNEY TO SCHOOL INCLUDING:
- Ensuring that my child arrives at the walking bus stop on time and are signed in by a responsible adult
- Ensuring that my child gets to school if they miss the walking bus
- Informing the bus co-ordinator if my child will not be using the walking bus
- Ensuring my child has their fluorescent bib on when they arrive at their bus stop
CHILD’S PROMISE

WHEN I JOIN THE WALKING BUS I PROMISE TO:
- Behave sensibly all the time
- Obey the instructions given by the bus driver and conductor
- Wear the fluorescent jacket I will be given
- Walk in a pair where possible
- Remember to STOP, LOOK, LISTEN and THINK when I am near roads
- Look after my own safety and not cause danger to others
- Always travel on the walking bus on the days I am expected to
- Arrive on time at the stop when I am using the bus
- Join my class line once the bell rings at school
I have talked to my child(ren) about the Child's Promise and it is fully understood and agreed on by me and my child(ren)*

YesNo
Any additional information or phone numbers that need to be recorded
Signature Parent/Guardian*
Consent to collection and use of personal information

I agree to the Cults Primary School Walking Bus retaining the personal information I give them for the purposes of running the Walking Bus service. Full privacy policy is available at https://www.cultsprimarywalkingbus.uk/data-collection-policy
Should be Empty:

Consent and Promise

Child Photo/Video Consent Form

Parent and Child's Promise