Parking Applications (Page 3 of 3) in pdf

Parking Applications Page 3

Madison Southern High School Parking Application

Ky. Operators License #___________________Vehicle License #___________________

Student's Name__________________________Grade______Date__________________

Address______________________________________________Phone_____________

Name of Parent/Guardian___________________________________Phone___________

Address (if different)______________________________________________________

Reason for Request_______________________________________________________

Insurance Company____________________________Policy Number_______________

Make of vehicle________________________________ Model_____________________

Color_________________________

Year_______________________

I have read and understand the information, regulations and policies for parking on the

school grounds.

_________________________________

Signature of student

Signature of Parent/Guardian

Permit approved by______________________

Permit and Space #______________

Parking Applications Page 3