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CONTACT INFO

  • 1-779-333-67992
  • info@business.com
  • Alkmaar, Netherlands
CONTACT: +240-458-7900
contact@cozytransdmv.com
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Student Registration Form

Student Registration Form

Please complete the following form to register your child for our transportation services.

STUDENT REGISTRATION FORM

Child/Student Age *

Child/Student Name *

Child/Student Grade *

Parent Name *

Number *

Alternate Number *

Student Number

Email *

Emergency Contact *

Number *

Home address *

Pick-up address *

Drop-off address  *

School Name *

What time does school start? *

What time does school end? *

Does Child/Student Require Car/Booster Seat? *

Transportation Days
Requested *

Are you requesting Service for AM or PM or BOTH?  *

School Year *

Please indicate which school year you are registering for and review updated rates on website for your school/academy.

Transportation Start Date *

Referred By: *
Terms of Agreement *
I understand that once my registration form is received, that due to backlog it may take between 1-5 days for my student to be added to a transportation schedule depending on route availability.  Once a route is confirmed and we know that we can transport your student, an email invoice will be sent for you to pay the applicable registration fee.

REGISTRATION FEE IS NON-REFUNDABLE & ABSOLUTELY NO REFUNDS IN ANY AMOUNT IF TRANSPORTATION SERVICE IS CANCELLED PRIOR TO THE END OF THE SCHOOL YEAR!

Price: $225.00