Student Name

Phone Number

Student #1 School: *


Sibling Student Name

Sibling Phone Number

Student#2 school

Sibling Grade

Mother Name*

Mother Phone Number*

Mother's Email*

Father Name*

Father's Phone Number

Father's Email

Home Address

(Street Address, City, Zip Code)

Trip Choice
One-Way MorningOne-Way AfternoonRound TripOther
(Please select the route choice for your student)

Do you agree to a $65 registration fee for families and/or $40 for individual students.Do you understand that the registration fee is NON-REFUNDABLE.Do you understand that a two week notice is required for cancellation.Do you understand that a $10 late fee per occurance will be added to late pick-up and/or drop off of student.Do you understand that failure to abide by the ridership agreement is grounds for dismissal and NO REFUND of payment.Do you understand that your student is required to remain seated in their seatbelt at all times while the van is moving.Do you understand that M & M has a NO BULLYING policy. Grounds for dismissal.Do you understand that M & M drivers are only allowed to exit the vehicle to open the door for students. If you need your student walked or signed in a escort fee is required.Do you understand if you are door-to-door your student is required to be ready for pick-up at the designated time. Failure to do so will result in missed pick-up.Do you understand that you are required to notify M & M if student will not attend school, has been picked-up early and/or was dropped off to school.