LORUSSO TRANSPORTATION LLC
New Student Registration
Thank you for contacting us. After you submit the application, we will contact you shortly.
Student Information
Student Name
*
First Name
Last Name
School:
*
Name of the school
Grade
Date of Birth
*
-
Month
-
Day
Year
Date
Student Address:
*
Street Address
Street Address line 2
City
State
Postal / Zip code
Additional Siblings Information
Opcional
Sibling 1 Name:
Name
Last Name
Birth Date
-
Mes
-
Día
Año
Sibling 2 Name:
Name
Last Name
Birth Date
-
Mes
-
Día
Año
Parent’s Information
Parent’s Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
example@example.com
Emergency Information
Emergency Contact:
*
Name
Last Name
Emergency Phone:
*
Format: (000) 000-0000.
Service Requested
Start Date
-
Mes
-
Día
Año
Date
Service requested
*
Round Trip
One Way Morning
One Way Afternoon
Afternoon Program
What is your preferred payment method? (payment must be made weekly)
Debit card/Credit card
Zelle
Cash
Is there anything else you’d like me to know?
Service Conditions and Terms
• I understand that this application has a cost, which is a one-time payment per registration. • I understand Payment must be turned in every Monday or the first day the student rides the bus. • I understand that a service fee will be charged at checkout for debit card or credit card transactions. Our company does not receive any part of this fee. • I understand that weeks are paid in full regardless of number of days the student rides the bus. • I understand that the student, inside the bus the basic rules of good behavior must be followed: do not say bad words, do not eat inside the unit, respect students and the driver. • I understand that the student have to be there at the scheduled times to provide a good service, both in the morning and in the afternoon.
*
I have read, understood and accepted all the conditions and terms proposed here for my transportation services
SUBMIT APPLICATION
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