ELCE Parent Transportation Agreement Form

Parent Transportation Agreement Form

Phone:312-515-6888 Email: info@elitelanechangeexpress.com www.elitelanechangeexpress.com
Child's Information

First NameLast Name
Date of Birth: Type a label
School Name: Type a label
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level: Type a label
Parent/Guardian Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Transportation Services Requested
Start Date:

MonthDayYear
Date
End Date (if applicable):

MonthDayYear
Date

Pick Up and Drop-Off Locations
Home Pick-Up Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Drop Off Location(s) Type a label
Drop-Off Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Special Instructions (If any):
Type a label
Medical or Behavioral Conditions Does your child have any allergies, medical conditions, or behavioral concerns the driver should be aware of?
If YES, please describe:
Authorization and Liability Waiver

By signing below, I understand and agree to the following:

·      I authorize Elite Lane Change Express, LLC. to transport my child as indicated above.

·      I confirm that my child will be ready for pick-up at the scheduled time and location.

·      I agree to notify the company at least 24 hours in advance for cancellations.

·      I understand that all drivers are CPR certified, properly licensed, insured, and background-checked.

·      I acknowledge that Elite Lane Change Express, LLC. will make every effort to ensure my child’s safety, but I release the company and its employees from liability in the event of unforeseen incidents outside of reasonable control.

·      I agree to the terms and conditions provided by the company.
Payment Terms and Agreement

· Accepted Payment Methods: (Cash, Credit Card, OR Zelle payments to 312- 515-6888)

· Late payments will result in a late fee and or service suspension.
Parent/Guardian Signature

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Printed Name
Date

MonthDayYear
Date
Should be Empty:

Parent Transportation Agreement Form

Pick Up and Drop-Off Locations