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2017-2018 Car Rider Registration Form 3/10/17, 9)14 AM

2017-2018 Car Rider Registration Form


Our goal is for every student to have a safe and efficient car rider pick-up experience at dismissal. In
order to accelerate the car rider pick-up process, please complete the following form. We will provide
you with an identification tag that can be displayed in your front windshield. The adults on duty will
use this information to direct your student(s) to your car's location. Your support and cooperation are
needed and appreciated as we work together to ensure a safe and speedy car rider pick-up process
for you and your student(s).

* Required

1. Name of Student: *

2. Student ID Number:

3. Name(s) of Parent/Guardian: *

4. Names of all Parents/ Guardians/ Emergency Contacts permitted by parent(s) to pick up


student in the car rider area: *
Please enter the full name and separate each contact with a comma. (i.e., Beverly Pilkey, Olga
Toggas, Kayla Maxwell)

5. First and last name of student to be


displayed on car rider identification tag: *

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2017-2018 Car Rider Registration Form 3/10/17, 9)14 AM

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