Transportation Registration | Prime Dallas Chauffeur

1. Parent / Guardian Information

Primary Parent / Guardian Name:

Relationship to Child:

Phone Number (Primary):

Phone Number (Secondary):

Email Address:

Home Address:

Preferred Method of Contact:

Call
Text
Email

Emergency Contact (Other than Parent):

Name

Phone Number:

Relationship:

2. Student Information

Child's Full Name:

Date of Birth:

Age:

Grade Level:

School Name:

School Address:

School Start Time:

School Dismissal Time:

3. Transportation Type Requested

Please select service type:

One-Way (Morning Drop-Off Only)
One-Way (Afternoon Pick-Up Only)
Round Trip (Morning & Afternoon)
Custom Schedule (Explain Below)

If custom, please describe days/times needed:

4. Schedule Details

Service Start Date:

Service End Date (if temporary):

Days of the Week Needed:

Monday
Tuesday
Wednesday
Thursday
Friday

Special Early Dismissal Days?

Yes
No

If yes, please provide details:

5. Pick-Up & Drop-Off Instructions

Morning Pick-Up Location (if different from home):

Preferred Pick-Up Time:

Special Instructions for Pick-Up (gate code, doorbell, etc.):

Afternoon Drop-Off Location: *

Home
After-School Program

Other (Specify)

Authorized Adults for Drop-Off (Name & Phone):

6. Safety & Medical Information

Does your child have any medical conditions?

Yes
No

If yes, please explain:

Does your child have allergies?

Yes
No

If yes, list allergies:

Is your child required to carry medication (EpiPen, inhaler, etc.)?

Yes
No

Emergency medical instructions:

8. After-School Activities (If Applicable)

Does your child participate in extracurricular activities?

Yes
No

If yes, list activity, location, and schedule:

Will transportation to activities be needed?

Yes
No

9. Billing Information

Parent/Guardian Responsible for Payment: Billing Address (if different from home):

Preferred Payment Method:

Credit/Debit Card
Zelle
Bank Transfer
Other

Do you prefer:

Weekly Billing
Monthly Billing
Per Ride

11. Policies & Permissions

Select All

I authorize the chauffeur service to transport my child as scheduled.
I understand cancellation policies.
I agree to notify the service of schedule changes in advance.
I consent to GPS tracking during rides for safety.
I authorize emergency medical care if necessary.

12. Additional Notes

Please include anything else we should know to ensure a safe and comfortable ride:

1. Parent / Guardian Information

2. Student Information

3. Transportation Type Requested

4. Schedule Details

5. Pick-Up & Drop-Off Instructions

6. Safety & Medical Information

8. After-School Activities (If Applicable)

9. Billing Information

11. Policies & Permissions

12. Additional Notes

How School Pick-Up and Drop-Off Services Works?