SIGN UP TO RIDE WITH UCTS

2X WEEK

$30

$60

per week

3X WEEK

$45

$90

per week

4X WEEK

$60

$120

per week

5X WEEK

$75

$150

per week

A non-refundable, one-time $50 registration fee will be applied at sign up.

Payment is due no later than 6pm Sunday the week prior to service. If payment is not received by 6pm there will be a $10 up charge per ride. Payment is due before service is rendered.

RIDER REGISTRATION

A one-time, non-refundable $50 registration fee is required upon sign up.

Child First Name

Child Last Name

Chlld Date of Birth

Chlld's Grade

Phone

Address

City

State

Zipe Code

School

Parent/Guardian Name

Emergency Contact Name

Emergency Contact Number

Emergency Contact's Relationship to Child

In the event of an emergency, I consent to first aid being administered to the child I have registered for this service.

Yes No

I understand a one-time, non-refundable $50 registration fee is due upon submission of this form and that my registration will not be considered complete until payment is received.

I understand

By submitting this application I am giving permission for my child to be Transported, via van, by United Childrens Transportation Services.

I agree

SIGN UP TO RIDE WITH UCTS

2X WEEK

3X WEEK

4X WEEK

5X WEEK

RIDER REGISTRATION

CONTACT US

RIDER

DRIVER

UCTS