Follow Us Contact Us: (305) 763-7022 Facebook Instagram Registration Form Type of Services Requested? (Required) Morning OnlyAfternoon OnlyBoth (Morning & Afternoon) Will someone be at the drop off location to receive your child? (Required) YesNoMy child has a keyDoes Not Apply *Note: Please be advised that parent/guardian should be available at least 30 minutes prior to drop off time. Redelivery is an additional $7 fee. If no one is at the drop off location, the child will NOT be left alone unless release waiver has been signed (Please be sure your child has a key to get in house). Yes, I understand / AgreeNo, I do not understand / Agree Special Needs or Requests Parent Information: *Payment Method? CashAppZelle Is this your child's first time using private transportation service? YesNo If no, which service have they used in the past? Reason for Leaving Previous Service PriceDid not Service my areaDissatisfied with serviceOther *Disclaimer: (Please read and check EVERY box) I certify that my answers are true and complete to the best of my knowledge. If my responses are inaccurate or there are any mistakes with the pickup or drop off address, I take full responsibility. I realize that Kidz Express Transportation Service cannot and will not be held liable for a mistake on my part. I certify that I have the authority to authorize and release the child being transported by Kidz Express Transportation Service to be transported. (Release Waiver) My signature (printed name) below indicates acknowledgement and acceptance of this application. Parent's Name Student's Name Date "Emergency Contact Information: Name of Emergency Contact 1: Phone Name of Emergency Contact 2: Phone Name of Emergency Contact 3: Phone Medical Conditions: My child has the following medical conditions AllergiesCommon Cold (Frequently)Nose BleedAutisticHypertensionADD / ADHD/ ESEOtherNone Registration Form Type of Services Requested? (Required) Morning OnlyAfternoon OnlyBoth (Morning & Afternoon) Will someone be at the drop off location to receive your child? (Required) YesNoMy child has a keyDoes Not Apply *Note: Please be advised that parent/guardian should be available at least 30 minutes prior to drop off time. Redelivery is an additional $7.00 fee. If no one is at the drop off location, the child will not be left alone unless release waiver has been signed (Please be sure your child has a key to get in house). Yes, I understand / AgreeNo, I do not understand / Agree Special Needs or Requests Parent Information: *Payment Method? CashAppZelle Is this your child's first time using private transportation service? YesNo If no, which service have they used in the past? Reason for Leaving Previous Service PriceDid not Service my areaDissatisfied with serviceOther *Disclaimer: (Please read and check EVERY box) I certify that my answers are true and complete to the best of my knowledge. If my responses are inaccurate or there are any mistakes with the pickup or drop off address, I take full responsibility. I realize that Kidz Express Transportation Service cannot and will not be held liable for a mistake on my part. I certify that I have the authority to authorize and release the child being transported by Kidz Express Transportation Service to be transported. (Release Waiver) My signature (printed name) below indicates acknowledgement and acceptance of this application. Parent's Name Student's Name Date "Emergency Contact Information: Name of Emergency Contact 1: Phone Name of Emergency Contact 2: Phone Name of Emergency Contact 3: Phone Medical Conditions: My child has the following medical conditions AllergiesCommon Cold (Frequently)Nose BleedAutisticHypertensionADD / ADHD/ ESEOtherNone
