Student Name (Rider) *

First Name

Last Name

Student's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Cell Phone *

(###)

###

####

Mother's Work

(###)

###

####

Father's Cell *

(###)

###

####

Father's Work

(###)

###

####

Round Trip (Semester)

$1600 (First child)

$1400 (Second child)

$1200 (Third child)

$1200 (Fourth child)

None

One Way - AM (Semester)

$1100 (First child)

$963 (Second child)

$825 (Third child)

$825 (Fourth child)

None