Summer Camp Transportation Agreement - International Preparatory Academy

Home Pick-up/Drop Off Only

I hereby agree that my child will not be released from the bus unless I or my authorized pick-up person personally comes to the bus to get my child or children. If the authorized person(s) is not available, I agree to plan to have my child(ren) picked up from the center and pay the fees associated with late pickup if arrival is after closing. After your child has been dropped off, International Preparatory Academy will not be held responsible for what happens to the child. I certify that I give International Preparatory Permission to Transport my child To/From the following:

From Pickup (HOME) Address:(Required)

Street Address City State ZIP Code

Time (am/pm)(Required)

To/From:(Required)

To Drop Off Location: CIRCLE YOUR SCHOOL LOCATION(Required)

IPA: 4138 Snapfinger Woods Dr., Decatur, GA 30035

IPA II: 10B Friendly Hills Dr., Decatur, GA 30035

IPA III: 2541 Glenvalley Dr., Decatur, GA 30032

Time (am/pm)(Required)

For the following Days: Check as needed(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

The Person to receive my child must be one from my authorized release list or the following:

Person #1 First/Last Name(Required)

Person #2 First/Last Name

Print Full Name(Required)

Full Signature(Required)

Date(Required)

All Full-Time & Summer Camp Students

To/From:

CIRCLE YOUR SCHOOL LOCATION(Required)

IPA: 4138 Snapfinger Woods Dr., Decatur, GA 30035

IPA II: 10B Friendly Hills Dr., Decatur, GA 30035

IPA III: 2541 Glenvalley Dr., Decatur, GA 30032

To/From:

Evacuation Location

Person to notify in an emergency and parents cannot be reached

Name

Relationship to Child

Home phone

Cell phone

In the event of an emergency involving my child, and if International Preparatory Academy Cannot get in touch with me, I hereby authorize any needed emergency medical care. I further agree to be fully responsible for all medical expenses occurred during the treatment of my child.

Print Full Name(Required)

Full Signature(Required)

Date(Required)

(Office Use Only) Witnessed by

Date

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.