Transportation Contract Form (Page 2 of 2) in pdf

portion of this agreement is held invalid, it is agreed that the balance shall notwithstanding, continue in full legal

force and effect.

The undersigned parents, guardians, legal representatives further acknowledge that they are authorized to

enter this agreement on behalf of the student(s), and the student’s parents, personal representatives, assigns,

heirs, and next of kin.

We request that the following persons be allowed to pick up our student(s) in the event we are unable to do

so:

Name ________________________________

Relationship _____________

Phone _______________

Name ________________________________

Relationship _____________

Phone _______________

Name ________________________________

Relationship _____________

Phone _______________

Name ________________________________

Relationship _____________

Phone _______________

Any changes to this list must be communicated in writing by the parent.

Payment Agreement

We, the undersigned parents, assume financial responsibility of $1,300.00 for round-trip transportation or

$650.00 for one-way transportation for the 2015-2016 school year. We understand and agree that the fee is a

commitment which is non-refundable and non-negotiable. A $200.00 deposit is due with contractual agreement

leaving a remaining balance of $1,100.00 round-trip or $450.00 one-way due and payable as agreed below. A

$200.00 discount is allowed for the 2

and 3

rider in the same family.

Payment Options:

Total contract price paid in full (Circle One: Full Time $1,300.00 | One-Way $650.00 and select payment)

__ Check Enclosed OR __

VISA / MasterCard / Discover (circle card type and enter info below)

Card Number _____________________________________ Exp __ / ___

OR:

$200.00 Deposit:

Check Enclosed OR

VISA / MasterCard / Discover (circle card type and enter info below)

Card Number _____________________________________ Exp __ / ___

and

Monthly Payments included in FACTS monthly withdrawal, May 2015-February 2016* (select one):

$110.00/month for full-time riders

$45.00/month for one-way riders

*Note: if registering after May 2015, monthly payments may be higher to meet the total balance due

Agreement

We, the undersigned, agree to all terms and conditions of this contract and to comply with all current

policies, rules, and regulations of Bishop Kenny High School, Inc. and any amendments or changes made to said

policies, rules, and regulations at Bishop Kenny High School’s sole discretion.

We agree to pick up our student(s) at the designated time. Failure to do so may result in dismissal from the

program.

Student’s signature

__________________________

Date ________________

Student’s signature

__________________________

Date ________________

Father/Guardian’s name

__________________________

Father/Guardian’s signature

__________________________

Date ________________

Mother/Guardian’s name

__________________________

Mother/Guardian’s signature

__________________________

Date ________________

Internal Routing:

___ Office of the President

___ Business Office

___ Bus Coordinator

Transportation Contract Form Page 2

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