Minor Travel Consent Form

Online Form

Print Friendly Version of Minor Consent Form

WOTA provides transportation for low income families when they are attending DHS and medical appointments. If your minor child is attending one of these appointments with you, please complete this form on behalf of the minor in addition to their registration form.

Phone

This field is for validation purposes and should be left unchanged.

Minor Full Name(Required)

Gender(Required)

Male

Female

Other

Minor Date of Birth(Required)

Minor's Age(Required)

Phone #

Disabilities of the Minor-Please List: (Must complete disability forms if applicable)(Required)

I/We authorize my child to travel with the following adult(s):

Adult Name

Relationship

Adult Name

Relationship

Absolutely no minors travel alone. All minors (regardless of age) and accompanying adults must have a completed registration form on file.

Parent/Legal Guardian Full Name(Required)

I am unable to use finger/mouse or file upload to sign and will only type my name in "Signature Typed" box below.

Yes

Parent / Legal Guardian Signature:(Required)

I am uploading my signature instead of finger/mouse signing.

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 512 MB.

I choose to upload a digital version of my signature.

Typed Parent Signature

Date of Signature(Required)