Student Parking Permit Application

Student Parking Permit Application
Date

MonthDayYear
Driver's Name"*

First NameLast Name
Grade*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth
Make & Model of Car
License Plate Number
Driver's License Number
Insurance Company
Guidelines
1. The vehicle must be parked in the specified location given by the administration.
2. There is to be no loitering in or around vehicles.
3. Anyone riding with the student driver must have written permission from parents on file in the office with specific instruction.
4. The administration reserves the right to suspend a car permit for failure to cooperate.
Student's Signature*
Parent's Signature*
Should be Empty: