Nova Geração Brazilian Jiu-Jitsu School Pick Up Authorization Form
Please fill in your details.
Student Name
Parent Name
Phone Number
Email
School name
School address
Student grade
Student teacher’s name
School Dismissal time
I authorize my child utilize the school bus of transportation for the NOVA GERAÇÃO AFTER SCHOOL PROGRAM. * Note: Maximum capacity is one person per seat belt.
EMERGENCY CONTACT
In case of emergency, I may be reached at:
Telephone(s):
In event that I cannot be reached, please contact:
Name of establishment / person
Telephone (s)
Health/accident insurance
My child is covered by 24-hour student accident insurance or family insurance
I do not have insurance. However, I will pay any and all medical bills for the urgent care of my chi
Insurance company info
Submit
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