Student Name *

First Name

Last Name

Student Phone Number *

(###)

###

####

Choose one *

Round-Trip

One-Way

Parent Name *

First Name

Last Name

Parent Phone Number *

(###)

###

####

Destinations *

Destination may vary depending on requests

Danbury, CT (I-84 Exit 4 McDonald’s Parking Lot)

Manchester, CT (I-84 Exit 63 Walgreen’s Parking Lot 149 Deming St. Manchester, CT 06042)

Tarrytown, NY (Westchester Marriot Parking Lot 670 White Plains Rd. Tarrytown, NY 10591)

Allentown, PA Airport

Newark, NJ Airport

Philadelphia, PA Airport

Person Picking Up *

First Name

Last Name

Phone Number of Person Picking Up

(###)

###

####

Departure Time

Hour

Minute

Second

AM PM

Arrival Time

Hour

Minute

Second

AM PM

Arrival Date

MM

DD

YYYY

Arrival Time

Hour

Minute

Second

AM PM

*I acknowledge that by checking this box a payment will be made to the student's account to finalize the transportation request. It authorizes the school to charge the student's account if a payment is not received by the deadline. A $50 will be charged for any incomplete request.

*I acknowledge that is the student's responsibility to be aware of when the transportation arrives.