Transportation

AUTHORIZATION which is valid from August 15, 2023 - June 15, 2024

I authorize Hands for Hope aka Hands4Hope LA to transport my minor child, or children, named on this form, in a company Bus or Van, driven by an individual authorized by Hands4Hope LA.

I understand my child/children will be expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or staff or volunteer.

I have read, understand, and discussed with my child/children the following: (1) While traveling in the motor vehicle driven by the H4H staff/driver, my child shall wear their safety belt at all times.

(2) Children are expected to listen and follow directions of the supervising staff/driver, and respect the staff/driver, other children, vehicles they ride in, and the people they travel with during the trip .

(3) Riding in a motor vehicle presents risks, including personal injuries or death from collisions or acts by riders, other drivers, or objects, and I assume those risks; and,

(4) My child is expected to remain seated, and not to be disruptive in any way to the staff/driver of the vehicle.

Number of children in the program?(Required)

Please enter a number from 1 to 3.

Student Name:(Required)

First Last

Student Name:

First Last

Student Name:

First Last

Parent or Legal Guardian - Full Name

First Last

Signature of Parent/legal guardian

Signing as parent/legalguardian for the child/children listed above.

Transportation $5 per week - PAY by CREDIT CARD

Student Name(Required)

First Last

Per Week:

includes fifty cent convenience fee, to cover some of Hands4Hope LA's costs in processing. Or, Pay in cash on site $5.

Price:

# weeks(Required)

How many weeks do you wish to pay for now?

Please enter a number from 1 to 4.

Your Name (parent/guardian)

First Last

Your email address, for confirmation and receipt.(Required)

Total

Payment Method*

American Express

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Transportation $5 per week - PAY by CREDIT CARD

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