Transportation Enrollment Form

Student's Name *

First Name Last Name

Date of Birth *

Date

Student's Name

First Name Last Name

Date of Birth

Date

Student's Name

First Name Last Name

Date of Birth

Date

Parent/Guardian Name *

First Name Last Name

Parent/Guardian Cell Phone Number *

Area Code Phone Number

Parent/Guardian Work Phone Number *

Area Code Phone Number

Parent/Guardian Email *

example@example.com

Parent/Guardian Name

First Name Last Name

Parent/Guardian Cell Phone Number

Area Code Phone Number

Parent/Guardian Work Phone Number

Area Code Phone Number

Parent/Guardian Email

example@example.com

Please list any allergies/medical conditions/special needs of student(s):

Church Pick Up/Drop Off Location:

Cedars of Lebanon SDA Church (Deep Creek, Chesapeake) Prentis Park SDA Church (Portsmouth)

Please indicate your transportation needs below:

Please list any other information which may be helpful to know about your student:

Prentis Park SDA Church, 3709 Winchester Drive, Portsmouth, VA 23707

Cedars of Lebanon, 1977 Cedars Road, Chesapeake, VA 23323

AM Pick Up Times

Prentis Park SDA Church	Cedars of Lebanon
6:45am	7:15am

PM Drop Off Times

Cedars of Lebanon	Prentis Park SDA Church
3:15pm (Mon - Thurs)	3:45pm (Mon - Thurs)
2:00pm (Friday)	2:30pm (Friday

Times listed are approximate and may fluctuate due to traffic and previous stop. If pick up or drop off is going to happen later than scheduled (due to traffic, etc), parent/guardian will receive a call/text from the van driver to communicate expected arrival time. Van driver will depart each location at the listed times. If parent/guardian is running late, they must communicate directly with the van driver.

Fee Schedule

Weekly	$40
Daily	$10
Per Ride	$6
Additional Student	$10

*Note that fees are used to cover costs of vehicle operation (gas, maintenance, tolls, driver, etc). Transportation is a service to TAA families and does not provide a profit to the school.

Students must be picked up and dropped off at a designated church location. Van will not make any additional stops.

Student must be signed in/out at each stop by the parent/guardian. Billing invoices will be created each week for previous week services rendered and must be paid within 5 business days. Failure to pay in a timely manner will result in a $10 late fee (to be billed the following Monday).

I have read and understand the Fee Schedule for Transportation, as well as pick up/drop off locations and times, and agree to pay for services rendered in a timely manner.

Signature

Clear

Date