WIMA & WIHI Carpool Survey

WIMA & WIHI Carpool Survey

For Newly Accepted & Current Students/Families Only
This survey is for WIMA & WIHI families interested in carpooling with other WIMA and WIHI families.

Please note that WIMA/WIHI does NOT provide carpool-matching services for families.

This is a parent led carpool only.

Feel free to contact any of families on the carpool spreadsheet (a link will be provided in August) to set up carpooling arrangements.
Parent/Legal Guardian Name: *

First Name Last Name
Parent/Guardian Email: *
example@example.com
Parent/Guardian #: *

Area Code Phone Number
Best way to contact you: *

Email Phone Text
Name(s) of Student's attending WIMA and/or WIHI: *
Grade Level for each Student
Student Information: *
Do you need a Carpool: *

Yes No
If Yes - when would you need it? (select all that apply *

Monday Tuesday Wednesday Thursday Friday Only on half days Summer School Only
Are you able to drive a carpool? *

Yes No On Occasion
If Yes or On Occasion- when can you drive? (select all that apply) *

Monday Tuesday Wednesday Thursday Friday Only on half days WIHI Summer School WIMA Summer School
Times you can drive (select all that apply): *

Morning (school start) Afternoon (school dismissal) After-School (4:00 pm or later for students who attend clubs or other similar activities at WIMAHI) Half-Day (Noon dismissal) WIHI Summer School - Morning Session WIHI Summer School - Afternoon Session WIMA Summer School
Address to Pick Up Student(s) at: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Is this the same address for drop off? *

Yes No
If No, please list Drop off Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Any additional information you would like to include:
Parent/Legal Guardian Signature: *

Clear
Today's Date:

Month Day Year
Date
Should be Empty: