Owner: Damaris M. Owner: Damaris M. Smith aris M. Smith

Transcription

CRUIZING KIDZ TRANSPORT SERVICE
Owner: Damaris M. Smith
Enrollment Packet
Providing SAFE transportation to your children in the
Lithonia, Decatur, Stone Mountain, Conyers and Covington areas.
“YOUR #1 KIDDY TRANSPORTATION SERVICE!!”
2055 Gees Mill Rd., Ste 321, Conyers, GA 30013
Office: 678
678-663-1015 ** Fax: 866-430-3898
www.cruizingkidz.com
TABLE OF CONTENTS
I.
History & Mission
II.
Fee Schedule
III. Application
IV. Authorization and Release Agreement
V.
Parent Agreement
VI.
Emergency Form
VII. Rules and Regulations
VIII. Audio/Video/Photo Release
IX. Parent Agreement Disclaimer Form
Office: 678-663-1015 ** Fax: 866-430-3898
I.
HISTORY & MISSION
Cruizing Kidz Transport Service is a safety first transportation company. The
company was founded in 2006 by Mrs. Damaris M. Smith with a vision and a need
for the service. Being the parent of three beautiful children with constant activities
to be taken to, along with a hectic working schedule, she quickly realized the
overwhelming stress it had placed on her family. It was a constant struggle for her
to balance her work and family life. After having no success with weeks of
researching alternative methods to assist her with getting her children to school and
having them picked up from their after school activities, she decided to put her
vision into motion. Mrs. Smith’s vision is to help busy families like hers by
eliminating the worry and stress associated with trying to stretch themselves to
thin. You can't be everywhere at once! Let us give you peace of mind and your
child(ren) the opportunity to enhance their academic and social growth by
transporting them to and from school and the various destinations you are unable to
get to. We are proud to say that after three years in business, we have successfully
helped many families become less hectic and uncomplicate their schedules
allowing them more flexibility and family time with each other. We provide a safe
comfortable ride while transporting our growing youth, servicing Lithonia,
Decatur, Stone Mountain and Conyers/Covington areas.
Cruizing Kidz strives to maintain its motto “With Safety as Our Goal” when
transporting your
child(ren).
We would welcome the opportunity
to earn your trust and deliver
You the best service in the industry!
Office: 678-663-1015 ** Fax: 866-430-3898
II.
FEE SCHEDULE
♦ $45.00 one way per week
♦ $60.00 round trip per week
♦ $20.00 fee for one day only (to & from)
♦ $25.00 application fee
PLEASE NOTE: Fees may be changed according
to the expected destination. If you live in Decatur,
Conyers or Stone Mountain, additional fees will be
added. You will be notified in advance before
service is provided. Flat fees only apply for those
living in Lithonia.
If you have any questions concerning the fee
schedule, please contact Mrs. Michelle or send an
email to [email protected].
Office: 678-663-1015 ** Fax: 866-430-3898
III.
APPLICATION
Parent/Guardian Information
Parent’s/Guardian’s Name(s): ____________________________________
Address ________________________ City: _______________________ State: ______
Home # ________________________ Cell # _______________________
Work # ________________________
Child(ren) Information
Name (First & Last) ________________________________________ Male/Female
Emergency Contact Information
Name: ___________________________________ Relationship: ___________________
Address: _________________________________ City: _____________ State: _______
Home: __________________Cell: __________________Work: ____________________
Destination of Services
Pick-Up ________________________________________________________________
Drop-Off _______________________________________________________________
Days of the week transportation is needed:
◊ Monday
◊ Tuesday
◊ Wednesday
◊ Thursday
◊ Friday
◊ Saturday
Payment Policies
*Payments are due in advance before transportation services are provided.
*Charges will be added to payments which aren’t received before 5:00pm on
expected due dates.
________________________________
Parent/Guardian Signature
__________________________
Date
Office: 678-663-1015 ** Fax: 866-430-3898
IV.
AUTHORIZATION AND RELEASE AGREEMENT
______________________, am the parent or legal guardian of ___________________ (Child’s
name). I authorize and direct Cruizing Kidz (Cruizing Kidz shall hereinafter refer to Cruizing
Kidz and its Subcontracted drivers) to transport my child to and from school, daycare, and field
trips.
In the event of a Cruizing Kidz vehicle emergency (eg. mechanical failure), I understand that
students may have to be transported in the personal vehicles of the driver. Cruizing Kidz strives
to maintain its motto, “With Safety as Our Goal” when transporting my child(ren).
I hereby Waive, Release, and Discharge Any and All Claim Against Cruizing Kidz for damages,
death, personal injury, or property damage/loss should my child suffer as a result of being
transported by Cruizing Kidz.
Each Waive and Release Agreement contained herein, I make on behalf of myself, my child, and
any other parent or guardian of my child. By these waivers and releases, I intend to give up my
right, the right of another parent of my child, or guardian to assert or maintain any claim or suit
against Cruizing Kidz for the destinations described.
I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THE WAIVERS AND
RELEASES CONTAINED HEREIN and I agree to indemnity and hold harmless Cruizing Kidz
for any liability of any kind that might arise due to unexpected emergencies.
I have read, understood and agreed with the terms and conditions above.
Signature _________________________ Date ____/____/____
Print Name _________________________
Should you have questions regarding this agreement, please contact Mrs. Michelle.
Office: 678-663-1015 ** Fax: 866-430-3898
V.
PARENT AGREEMENT
∗ Payment is to be made in advance for that week.
A late fee of $10.00 will be added to payment for
child(ren) if the payment is not received by the close
of business on Mondays, which is 5:00 p.m.
∗ If payment is not paid by the end of the week, you
will be asked to make arrangements for your
child(ren). NO EXCEPTIONS!!!!
∗ There is an additional $10.00 for each occurrence that
our drivers are not notified of any cancellations or
change in transportation arrangements.
If you have any questions concerning the Parent Agreement, please
contact Mrs. Michelle or send an email to [email protected].
Parent: _______________________ Date: ________
Provider: _____________________ Date: _______
Office: 678-663-1015 ** Fax: 866-430-3898
VI.
EMERGENCY FORM
Child’s Name
Parent’s/Guardian’s Name
([
])
Home Phone
M
F
Sex
Date of Birth
Cell Phone
([
])
Work Phone
Parent’s/Guardian’s Name
Cell Phone
([
])
Home Phone
([
])
Work Phone
Address
Address
City, ST ZIP Code
City, ST ZIP Code
Alternative Emergency Contacts
Primary Emergency Contact
([
])
Home Phone
Relationship
([
])
Work Phone
Secondary Emergency Contact
([
])
Home Phone
Relationship
([
])
Work Phone
Address
Address
City, ST ZIP Code
City, ST ZIP Code
Medical Information
Hospital/Clinic Preference
Physician’s Name
Phone Number
Insurance Company
Policy Number
Allergies/Special Health Considerations
I hereby authorize Cruizing Kidz Transport Service to give consent for all medical and/or surgical treatment that may be required
for our child(ren) during our absence.
Parent’s/Guardian’s Signature
Date
Office: 678-663-1015 ** Fax: 866-430-3898
VII.
RULES AND REGULATIONS
NO PROFANITY
NO HORSE PLAY ON VAN
SEAT BELTS ARE TO BE WORN AT ALL TIMES
NO EATING OR DRINKING ON THE VAN UNLESS GIVEN PERMISSION
NO FIGHTING OR DISRESPECTING OF OTHER CHILDREN
NO DAMAGING TO VAN
LAST AND FORMOST ALWAYS NO BACK TALKING TO VAN DRIVERS
“AS ALWAYS SAFETY IS OUR MOTTO”
PARENTS WILL ALWAYS BE INFORMED OF ANY EXCESSIVE AND/OR
UNCONTROLLABLE BEHAVIOR.
ANY BEHAVIOR THAT IS UNCONTROLLABLE MAY RESULT IN SUSPENSION
AND/OR TERMINATION OF TRANSPOTATION SERVICES.
Child(ren)’s Signature: ______________________________________ Date: ________________
Parent Signature: ___________________________________________ Date: ________________
Office: 678-663-1015 ** Fax: 866-430-3898
VIII.
AUDIO/VIDEO/PHOTO
AUTHORIZATION RELEASE
I give permission for my child(ren) to be taped recorded, video recorded, or photographed for
transportation or publicity purposes while being transported to and from regular activities of our service.
Signature: __________________________________ Date: __________________________________
I do not give my child(ren) permission to be taped recorded, video recorded, or photographed for
transportation or publicity purposes while being transported to and from regular activities of our service.
Signature: ________________________________ Date: ___________________________________
If you have any questions regarding any photos or audio releases you may contact
Mrs. Michelle.
Office: 678-663-1015 ** Fax: 866-430-3898
Parent Agreement Disclaimer Form
This agreement is made this _____ day of ____, 20___, by and between Cruizing Kidz Transport
Service and _____________________________.
I, ___________________________________, parent of _____________________ have read,
understand and agree to the terms and conditions of Cruizing Kidz Transport Service.
Beginning the ______ day of ____, 20___, Cruizing Kidz Transport Service will provide
transportation for said child in the agreed amount of __________ per week/month.
You agree by signing this agreement that:
You have read it
You understand it and
You have received a signed copy of it
_____________________________________________
Parent Signature
_____________________________
Date
______________________________________________
Cruizing Kidz Transport Service Representative/Title
______________________________
Date
Office: 678-663-1015 ** Fax: 866-430-3898

Owner: Damaris M. Owner: Damaris M. Smith aris M. Smith

Transcription

Similar documents

KIDZTOWN NEWS_AUGUST 14th

Important dates: February 4: Star Educational Show : “My

KFC Kid Newsletter

the week at a glance - Islesboro Community Center

BLACK HOLIDAY GIFTS GUIDE BLACK HOLIDAY

February 2013

Sat., August 16 - Wooster Church of the Nazarene

Sonshine Corner - Raymond Christian Reformed Church

Kidz Kartz - Gravitron

Race: Sunday, December 13, 2015 5K: 8:30am start • Kidz Run 9

Untitled - KidzMondo