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Chamlian Carpool Form

Student 1 Full Name*

Answer Required

Student 1 Homeroom*

Answer Required

Parent/Guardian 1 Full Name *

Answer Required

Parent/Guardian 1 Phone Number*

Number Required

Car 1 Make/Model *

Answer Required

Car 1 License Plate Number*

Answer Required

Student 2 Full Name*

Answer Required

Student 2 Homeroom*

Answer Required

Parent/Guardian 2 Full Name*

Answer Required

Parent/Guardian 2 Phone Number*

Answer Required

Car 2 Make/Model*

Answer Required

Car 2 License Plate Number*

Answer Required

If there are additional students included in the carpool, please list the names and homeroom classes here

Answer Required

I have read and understand the terms and conditions for the carpooling incentives listed on the school website.*

Answer Required

Yes

I understand that each carpool vehicle is required to display the decal provided by the school.*

Answer Required

Yes

I understand that, in order to qualify for the monthly $75 tuition discount per car, a five-day commitment is required.*

Answer Required

Yes

Confirmation Email

Confirmation Email *

Email Required