KidEx Transportation Registration
Parent Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information
Emergency Contact 1
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to the Child
*
Emergency Contact Information
Optional Emergency Contact 2
Full Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to the Child
Child Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Name of School
*
Please Select
Eagle Point Elementary
Indian Trace Elementary
Everglades Elementary
Country Isles Elementary
Manatee Bay Elementary
Gator Run Elementary
Falcon Cove Middle School
Tequesta Trace Middle School
Grade
*
Pickup Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Drop-Off Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorized Pickup Persons (If Any)
*
N/A if none
Any Allergies or Medical Conditions?
*
N/A if none
Account Security
Create a Password
*
Your Password
Verify Email
*
example@example.com
Verify Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Up PIN for Ride Authorization (Optional)
Select a Subscription Plan:
KidEx Lite
KidEx Unlimited
KidEx VIP
Subscription Start Date:
-
Month
-
Day
Year
Date
Submit
Should be Empty: