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 costs $5 per week.

Payment is required at the BEGINNING of the month.

Pay Online System

"*" indicates required fields

Student's Name*

First Last

Payment Type:

Credit Card Online

Cash or Check

Credit Card Online Payment Amount*

Cash or Check Payment Amount*

(you may add a note here if needed, up to 80 characters

Staff Use Only*

Staff accepting cash or check, authorization code

Staff Only - authorization*

Total

Payment Method

American Express

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Your email address if you want a H4H Receipt

If you leave blank, it will just show up on your credit card if you're paying that way.

Pay Online System

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