Chamlian Shuttle Service

Please complete the form below. All fields are required.

We (parent or guardian) of*

Student's name

Answer required for "We (parent or guardian) of"

Student's Homeroom*

Answer required for "Student's Homeroom"

give permission for our child to ride the shuttle from Park & Ride located at 3930 Lowell Ave. in La Crescenta to Chamlian Armenian School and back again each school day, in the morning and after school. It is understood that he/she will be under the supervision of a teacher/staff member of Chamlian Armenian School.

Answer Required

I/We understand that he/she will be under the supervision of their teacher/staff member of Chamlian Armenian School. I understand that, under Section 35330 of the California Education Code, all persons making such a field trip or excursion shall be deemed to have waived all claims against Chamlian Armenian School or the State of California for injury, accident, illness, or death occurring during or by reason of the field trip or excursion. We accept full responsibility for our child and grant permission to the person in charge to seek first aid treatment in case of emergency.

Parent/Guardian Name*

Answer required for "Parent/Guardian Name"

Parent/Guardian Phone Number*

Number Required

Morning shuttle pick up time slot*

Answer required for "Morning shuttle pick up time slot"

7:55 am

8:05 am

8:15 am

Afternoon shuttle pick-up time slot*

Answer required for "Afternoon shuttle pick-up time slot"

2:50 pm (available for students in TK-2nd grade only)

3:05 pm (available for students in TK-5th grade only)

3:20 pm (available for all students in TK-8th grade)

3:40 pm (available for all students in TK-8th grade)

Emergency Contact Name*

Answer required for "Emergency Contact Name"

Emergency Contact Phone Number*

Number Required

Relationship to Student*

Answer required for "Relationship to Student"

I have read and understand the terms and conditions for the Chamlian Shuttle Service listed on the school website.*

Answer required for "I have read and understand the terms and conditions for the Chamlian Shuttle Service listed on the school website."

Yes

I understand that if I do not follow the shuttle service guidelines provided, my child will lose privileges to the service.*

Answer required for "I understand that if I do not follow the shuttle service guidelines provided, my child will lose privileges to the service."

Yes

Please fix the highlighted areas below before submitting.

Chamlian Shuttle Service