Transportation Form 2025-2026

Transportation in Indianapolis 2025-2026

If you have questions about transportation services, please contact Christina Cockrell at ccockrell@persisteducationservices.com
About Transportation Services

Safe Route Transportation Services (SRTS) provides safe, reliable, door-to-door transportation for families in Indianapolis. SRTS provides before and after school transportation with special accommodations for students with special needs, students who qualify as McKinney-Vento, and students living in foster care. Transportation is also provided for appointments, events, and small groups.

Why Indianapolis Families Choose Safe Route:
- Licensed and insured professional drivers led
- Door-to-door pick-up and drop-off
- Text updates and vehicle location tracking
- Specialized care for children and adults with special needs
- McKinney-Vento and foster care transportation support
- Sibling discounts available (siblings ride for $25)
Weekly Rates for School Transportation:
- Standard Services
  - One-time request: $55
  - One-way: $100/week
  - Round-trip: $150/week
- Specialized Services (McKinney-Vento, Foster Care, Special Needs)
  - One-time request: $55
  - One-way: $150/week
  - Round-trip: $175/week
Weekly Rates for Wellness Programs/Services:
- Weekday (Mon-Fri)
  - Single Trip: $55
  - Daily Trips: (for regularly scheduled services)
    
    Option 1: 3 days at $150 per week
    
    Option 2: 5 days at $175 per week
- Weekend (Sat-Sun)
  - Single Trip: $75 plus 1.50 per mile (round-trip)
Indianapolis Service Areas for School Transportation

Marion and Hamilton County (zip codes may include 46226, 46208, 46205, 46220, 46202, 46218, and 46219)
Service Type*

School Transportation
Parent/Legal Guardian 1 Name*

First NameLast Name
Parent/Legal Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone Number*
Please enter a valid phone number.
Parent/Legal Guardian 2 Name

First NameLast Name
Parent/Legal Guardian 2 Email
example@example.com
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
Pick-up Address (starting location)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address Type*
Emergency Contact 1 Name*

First NameLast Name
Emergency Contact 1 Phone Number*
Please enter a valid phone number.
Emergency Contact 2 Name*

First NameLast Name
Emergency Contact 2 Phone Number*
Please enter a valid phone number.
I am seeking:
Desired Start Date:

MonthDayYear
Date

Student Information
Child 1 Name*

First NameLast Name
Child 1 Age*
Child 1 Grade*
Name of School*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Start Time*

Hour Minutes

AM/PM Option
School End Time*

Hour Minutes

AM/PM Option
Earliest Drop-off Time*

Hour Minutes

AM/PM Option
Latest Pick-up Time*

Hour Minutes

AM/PM Option
Child 2 Name

First NameLast Name
Child 2 Age
Child 2 Grade
Name of School
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Start Time

Hour Minutes

AM/PM Option
School End Time

Hour Minutes

AM/PM Option
Earliest Drop-off Time

Hour Minutes

AM/PM Option
Latest Pick-up Time

Hour Minutes

AM/PM Option
Child 3 Name

First NameLast Name
Child 3 Age
Child 3 Grade
Name of School
School Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
School Start Time

Hour Minutes

AM/PM Option
School End Time

Hour Minutes

AM/PM Option
Earliest Drop-off Time

Hour Minutes

AM/PM Option
Latest Pick-up Time

Hour Minutes

AM/PM Option
Child 4 Name

First NameLast Name
Child 4 Age
Child 4 Grade
Name of School
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Start Time

Hour Minutes

AM/PM Option
School End Time

Hour Minutes

AM/PM Option
Earliest Drop-off Time

Hour Minutes

AM/PM Option
Latest Pick-up Time

Hour Minutes

AM/PM Option
What days do you need transportation?*

MondayTuesdayWednesdayThursdayFriday
Are there any behavioral or medical needs we should be aware of? *
Additional Notes (please share any additional information that will help us better understand and meet the needs of your family):

Agreement and Consent
SRTS Responsibilities:

Safe Route Transportation Services (SRTS) will take the following reasonable steps to ensure the safety of all passengers during transportation, including but not limited to:
- Ensuring that the transportation provider is insured;
- Ensuring that the transportation provider's vehicle is in good, working condition and has appropriate safety features;
- Ensuring that the driver of the vehicle is licensed and qualified to operate the vehicle and has passed a background check, including BMV driving history, CPI/CPS history, and the Department of Justice; and
- Ensuring that your child(ren) is/are properly secured in the vehicle with appropriate safety restraints.
Service Agreement:
- Parent/Guardian will ensure child(ren) are ready for morning pick-up 10 minutes prior to scheduled pick-up time to avoid delays. The driver will leave after waiting 2 minutes after the scheduled pick-up time.
- Parent/Guardian will contact SRTS if child(ren) will not be attending school for any amount of time due to sickness, vacation, etc.;
- Keep contact information accurate and up-to-date;
- Parent/Guardian will ensure an authorized adult is present for afternoon drop-off for children in grades kindergarten through fourth grade; a parent/legal guardian may sign a waiver authorizing SRTS to release a child as young as 3rd grade without an authorized adult present; A parent must sign a waiver authorizing SRTS to release a child with a sibling 12 years of age and older;
- An additional fee of $25.00 will be assessed if the driver must drop-off a child at an alternative location.
Payment Agreement:
- Payments are automatically processed on Fridays, prior to the week of service.
- An additional fee of $10 will be assessed for declined/failed payments.
- Transportation will not be provided Tuesday-Friday if payment is not submitted by the end of day on Monday.
- Parent/Guardian must provide authorization for SRTS to automatically process the weekly transportation fee.
- Missed Payment Policy: In the event that a weekly payment is missed, the parent or guardian is required to submit full payment for all outstanding weeks in order for the student to continue transportation services.
  Example: If payment for Week 1 is missed and the parent/guardian wishes for the student to resume services in Week 2, payment for both Week 1 and Week 2 must be submitted prior to reinstatement on the transportation route.
- SRTS does not pro-rate weekly service rates for student absences. If you wish to pause services for any reason, you may send an email to ccockrell@persisteducationservices.com and you will not be billed for continued services. Please note that this means your student's seat on the van may not be reserved.
Release of Liability:
- I understand that Safe Route Transportation Services (SRTS) is a third-party transportation provider, not associated with any school or district and may provide the transportation services as requested. SRTS is not an extension of the school or organization where my child(ren) will receive transportation.
- I understand that my child(ren)'s safety during transportation cannot be guaranteed and that there are risks associated with any form of transportation. I agree to release and hold harmless SRTS, the transportation company, its employees, agents, and contractors, from any and all liability for any injury or harm that may occur during transportation to or from the expressed pick-up and drop-off locations.
- I understand that once my child(ren) is/are released from the care of Safe Route Transportation Services (SRTS) at the expressed drop-off location(s), SRTS is no longer responsible for my child(ren). I agree to release and hold harmless SRTS, the transportation company, its employees, agents, and contractors, from any and all liability for any injury or harm that may occur after my child(ren) is/are released at the expressed location(s).
Consent:

By signing below, I, the undersigned parent or legal guardian of the above-named child(ren), hereby authorize Safe Route Transportation Services to transport my child(ren) to and from the expressed pick-up and drop-off locations.

By signing below, I certify that I am the parent or legal guardian of the child(ren) being transported and that I am authorized to give consent to SRTS to provide transportation.

By signing below, I certify that I have read, understand, and agree to the terms of this waiver and consent form and that I have had an opportunity to ask any questions that I may have regarding Safe Route Transportation Services.

Questions about our Indianapolis school transportation services? Contact Christina Cockrell at ccockrell@persisteducationservices.com
Date

MonthDayYear
Date
Name of Parent/Legal Guardian*
Signature of Parent or Legal Guardian*

Clear

Passenger Information
What is the name of the person completing this form?*

First NameLast Name
What is your relationship to the passenger?*

SelfMotherFatherLegal GuardianHealthcare ProfessionalOther
Phone Number for Person Completing this form*
Please enter a valid phone number.
Full Name of Passenger*

First NameLast Name
Passenger's Date of Birth*

MonthDayYear
Date
Passenger's Phone Number*
Please enter a valid phone number.
Passenger's Email*
example@example.com
How do you plan to pay for transportation services?*

Private Pay (self-pay)Medicaid (approval required)
Medicaid Member ID (Required if using Medicaid benefits to cover services

Appointment Details
Pick-up Address (starting location) *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Drop-off Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this trip one-way or round-trip?*

One-wayRound-trip
Emergency Contact Name*

First NameLast Name
Relationship to Passenger*
Emergency Contact Phone Number*
Please enter a valid phone number.
Will you be accompanied by an attendant on this trip?*

YesNo
Frequency of trip?*

One-timeRecurring (e.g. daily or weekly)
Is this a weekday or weekend trip?*

Weekday: Monday-FridayWeekend: Saturday-Sunday
Please explain how often you need this service (example: 3 times a week for 4 weeks)*
Desired Start Date:*

MonthDayYear
Date

Liability and Agreement
SRTS Responsibilities:

Safe Route Transportation Services (SRTS) will take the following reasonable steps to ensure the safety of all passengers during transportation, including but not limited to:
- Ensuring that the transportation provider is insured;
- Ensuring that the transportation provider's vehicle is in good working condition and has appropriate safety features;
- Ensuring that the driver of the vehicle is licensed and qualified to operate the vehicle and has passed a background check, including BMV driving history, CPI/CPS history, and the Department of Justice; and
- Ensuring that all passengers are properly secured in the vehicle with appropriate safety restraints.
Service Agreement:

By signing this agreement, you acknowledge and agree to the following terms and conditions of Safe Route Transportation Services:
- Scope of Service: Safe Route Transportation Services provides non-emergency transportation for passengers to and from designated locations as agreed upon during the intake process.
- Passenger Responsibilities: Passengers are expected to be ready at the scheduled pickup time. If the passenger requires special assistance or equipment, this must be disclosed in advance.
- Safety and Compliance: All passengers must wear seatbelts or appropriate restraints (e.g., car seat, booster) during transport. Passengers must follow instructions from the driver to ensure safety during the trip.
- Payment and Fees: Payment is due as agreed upon during the booking process. Non-payment may result in suspension of services. Any additional charges for services (e.g., wait-and-return or unscheduled stops) will be communicated and billed accordingly. This includes transporting to an emergency facility in cases of emergency.
- Cancellations and Changes: Cancellations or schedule changes must be communicated at least [24 hours] in advance to receive a refund.
  Medical and Emergency Situations: Safe Route Transportation Services is not a medical transport provider. In case of a medical emergency, emergency services (e.g., 911) will be contacted.
- Termination of Service: Safe Route Transportation Services reserves the right to terminate or refuse service for non-compliance with this agreement, disruptive behavior, or safety concerns.
- Medicaid-covered passengers must get approval prior to services rendered. Safe Route must submit for prior authorization before accepting a trip.
Release of Liability
- I understand that passenger safety during transportation cannot be guaranteed and that there are risks associated with any form of transportation. I agree to release and hold harmless SRTS, the transportation company, its employees, agents, and contractors, from any and all liability for any injury or harm that may occur during transportation to or from the expressed pick-up and drop-off locations.
- SRTS is not responsible for the loss, theft, or damage of any personal belongings brought onto the vehicle.
  Consent:
By signing below, I certify that I have read, understand, and agree to the terms of this waiver and that I have had an opportunity to ask any questions that I may have regarding Safe Route Transportation Services.
Date*

MonthDayYear
Date
Full Name*
Relation to Passenger*
Signature*

Clear

Event/Small Group Transportation
Event Transportation Rates:
- $250 - Round-trip, up to 4 hours (up to 20 miles); $1.00/mi beyond 20 miles
- $450 - Round-trip, up to 6 hours (up to 20 miles); $1.00/mi beyond 20 miles
*Long distance trips that require our drivers to stay overnight will accrue a $250 service fee per night

Shuttle Service:
- $450 plus $1.00 per mile (up to 6 hours)
*Please contact us by email before registering for shuttle services*
Name of person completing this form*

First NameLast Name
Name of Organization*
Position*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Name of point of contact during the trip (person attending the trip)*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Event Date*

MonthDayYear
Date
Time of Event*

Hour Minutes

AM/PM Option
Starting Address (pick-up location)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Location (drop-off location)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Passengers (up to 11)*

Liability and Agreement
SRTS Responsibilities:

Safe Route Transportation Services (SRTS) will take the following reasonable steps to ensure the safety of all passengers during transportation, including but not limited to:
- Ensuring that the transportation provider is insured;
- Ensuring that the transportation provider's vehicle is in good working condition and has appropriate safety features;
- Ensuring that the driver of the vehicle is licensed and qualified to operate the vehicle and has passed a background check, including BMV driving history, CPI/CPS history, and the Department of Justice; and
- Ensuring that all passengers are properly secured in the vehicle with appropriate safety restraints.
Service Agreement:
- SRTS will provide round-trip transportation to/from the event location indicated in this agreement.
- Passengers agree to follow all safety instructions and rules provided by SRTS staff or drivers. Failure to comply may result in immediate suspension or termination of services without refund.
- The point of contact listed in this agreement is responsible for reinforcing safety instructions and rules for minor passengers.
- The point of contact listed in this agreement is responsible for ensuring permission from the parent or legal guardians of all minor passengers is granted. SRTS is not responsible for gaining parent/guardian consent to travel.
- The point of contact listed in this agreement and/or all other non-SRTS staff accompanying minor passengers are solely responsible for managing any medical needs presented by minor passengers. In the event of a medical emergency during transportation, the Client authorizes SRTS to take appropriate action, including contacting emergency services. The Client agrees to bear any costs incurred for medical treatment or transportation to a medical facility.
- Clients agree to pay the agreed upon transportation fee at least 5 business days (i.e. Monday-Friday) prior to the date of service.
- Clients agree to pay the transportation fee in full upon receipt of the invoice, prior to services rendered.
- Clients must provide at least a 48 hour notice of cancellation prior to the date of service. If the client cancels with less than 48 hours notice, payment is non-refundable. In the event of a crisis, SRTS may reschedule the trip for another date.
Release of Liability:
- I understand that Safe Route Transportation Services (SRTS) is a third-party transportation provider, not associated with any school or district and may provide the transportation services as requested. SRTS is not an extensions of the school or organization.
- I understand that passenger safety during transportation cannot be guaranteed and that there are risks associated with any form of transportation. I agree to release and hold harmless SRTS, the transportation company, its employees, agents, and contractors, from any and all liability for any injury or harm that may occur during transportation to or from the expressed pick-up and drop-off locations.
- SRTS is not responsible for the loss, theft, or damage of any personal belongings brought onto the vehicle.
  Consent:
By signing below, I certify that I have read, understand, and agree to the terms of this waiver and that I have had an opportunity to ask any questions that I may have regarding Safe Route Transportation Services.
Date*

MonthDayYear
Date
Full Name*
Signature*

Clear
Should be Empty:

Transportation in Indianapolis 2025-2026