Kid Express Shuttle Reservations

Please complete this registration form to arrange for transportation service All information you provide will be kept confidential. Each request will be processed promptly and you will receive a phone call to finalize any details and to let you know how we can accommodate your request.

We welcome your questions and comments at any time, as well as the chance to meet you and your child. Feel free to come by and check out our shuttles. We want you to feel comfortable with your decision to use Kid Express, LLC for your precious cargo.

Personal Details
Your email:	*
Parent(s) Name:	*
Street Address:	*
City:	*
Subdivision:
Zip/Postal Code:	*
Home Phone:
Work Phone:
Cell Phone:
Discount Code:
How did you hear about us?	superpages.com yellowpages.com craigslist.com newspaper magazine flyer business card employee current customer school saw shuttle driving found on internet Mamasource.com HOA website Other
Name of referral:	please specify the employee, customer, newspaper magazine, homeowners association or search engine so we may credit participants in our referral program
Child's Information
Child's FULL Name:	*
Use the address from above:
Child's home address:	*
City:	*
Subdivision:
Zip/Postal Code:	*
List Medical Conditions
List Known Allergies
Booster seat required?
Required Text Messaging Information
We provide notification of your child's location by text messaging. Please provide a mobile phone or cell phone number where you can receive these alerts.
Cell phone for Notifications	*
Trip / Reservation Information
Days needed
AM     M   T   W   T   F
PM     M   T   W   T   F
Date Service Begins
Date Service Ends
Origin Description Daycare Child’s home Parent’s employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Origin name/address information – include cross streets
Approximate pickup time:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Contact at this origin point
Contact's telephone
Destination 1 Daycare Child’s home Parent’s employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Name/address information – include cross streets
Needs to arrive by	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Must be picked up by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Delivered to destination by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Contact at this destination
Contact's telephone
Destination 2 Daycare Child’s home Parent’s employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Name/address information – include cross streets
Needs to arrive by	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Must be picked up by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Delivered to destination by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Contact at this destination
Contact's telephone
Destination 3 Daycare Child’s home Parent’s employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Name/address information – include cross streets
Needs to arrive by	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Must be picked up by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Delivered to destination by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Contact at this destination
Contact's telephone
I agree to follow the guidelines with Kid Express Shuttle, LLC, as outlined in the policies and pricing schedule pages. I understand that my child WILL NOT be transported without first signing a General Terms and Conditions Document.

We cannot schedule service unless you agree to the terms and conditions.