Transportation

AUTHORIZATION which is valid from is valid from August 12th, 2024 - June 10th, 2025

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

Payment Amount*

Staff Use Only

Auth Code for staff accepting cash or check

Staff Use Only

Initials

Total

Credit Card Authorization

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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