Child Transportation Agreement Form

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Transportation Agreement
This is to certify that I give _________________________________________________
Name of Facility
Permission to transport my child _____________________________________________
Name of Child
from _______________________________________ at __________________ (am/pm)
Pickup Location
to _________________________________________ at ___________________(am/pm).
Delivery Location
My child will be transported from __________________________at ___________(am/pm)
to ______________________________________ at _______________________(am/pm)
Delivery Location
on the following days:
_____________________________ Monday
_____________________________ Tuesday
_____________________________ Wednesday
_____________________________ Thursday
_____________________________ Friday
__________________________ is authorized to receive my child. In the event the authorized
Name of Authorized Person
person is not present to receive my child, the following procedures are to be followed:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
The _______________________________is approximately _________ miles from the center.
Location
In the event that my child is not to be transported as outlined above, I agree to notify the
_________________________________________.
Facility
Signature (Parent/Guardian) _________________________________ Date ______________

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