2021-2022 Parent-Sponsored Bus Registration Form

2021-2022 Parent-Sponsored Bus Registration Form - PRMS Student Services, Inc.

The undersigned parents or legal guardians/custodians (collectively, “Parents”) of the below identified child (“Child”) hereby acknowledge and agree to the terms and conditions identified below, for Child to participate in a program for bus transportation to and from Paul Revere Charter Middle School (“Paul Revere”) for the 2021-2022 school year coordinated by PRMS Student Services, Inc. (the “Program”), as described herein.

Parents agree to pay $2,050.00 for transportation of Child to and from Paul Revere from the first day of the school year, not yet officially announced but estimated to be on or around August 17, 2021, to on or around June 10, 2022, the last day of the school year (“Program Term”). Such payment shall be made in full by May 31, 2021 by credit card (plus credit card processing fee) or by check, made payable to: PRMS Student Services, Inc., mailed to P.O. Box 953, Pacific Palisades, CA 90272. Child will be assigned to a route with the stop requested, but not guaranteed to be on a specific route (such as with another specific student), except that we will always assign siblings to the same bus. If your route is full at the time of payment, you will be placed on a wait list, reimbursed, and contacted should a seat become available at a later date. Late payments will incur an additional charge and result in the Child’s exclusion from bus transportation. For payments and more information go to: PaulRevereMS.com/Buses

Email address *

I understand that there are no refunds of any kind once payment is made and seat availability confirmed by PRMS Student Services, Inc. Payments will not be accepted until LAUSD confirms a start date for the 2021-2022 school year and COVID-19 restrictions, if any, are known. Submitting this application is a request to reserve a seat. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Select Route (See routes at www.PaulRevereMS.com/buses. Routes subject to change based on registration and enrollment. Selection of bus stops within routes will be presented at a later date with payment details. *

900 | 901 - Pacific Palisades

902 - Valley | Brentwood

903 |904 - Holmby Hills & WeHo (Warner El., Fairburn El., WeHo El.)

905 | 906 - Westwood (Westwood Charter El.)

907 - Palms & Baldwin Hills (Overland El. School & Baldwin Hills El.)

908 - West LA & Venice (Coeur d'Alene El., Venice High, Mar Vista El., Clover El.)

Required

Authorization for Alternate Bus Stop allowing your child to get off the bus at any bus stop along the route for which they are assigned. The bus driver will permit your child to disembark at any bus stop on their route. This Authorization DOES NOT permit your child to change bus routes, and they MUST always ride on their assigned bus. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

No, do not allow my child to use any stop along the route other than the assigned stop.

Required

Student Date of Birth *

YYYY

Student Grade Level in 2021-2022 *

Required

Student Name (Last, First) *

Student Home Full Street Name *

Student Home City *

Student Home State *

Student Home Zip Code *

Student Regular Physician Name *

Student Regular Physician Phone *

Student Current Medical Conditions (asthma, diabetes, epilepsy, etc.) or None *

Student Allergies or Allergic Reactions or None *

Medical Insurance Company or None *

Medical Insurance Company Plan and Identification Number or None *

Parents understand that in the case of illness or injury to your child, the school and/or Tumbleweed will try to notify you or the person you have listed as an emergency contact. In case of medical emergency concerning your child, at a time when parents or listed emergency contact cannot be notified, Parents grant full power to the School/PRMS Student Services, Inc.,/Tumbleweed Transportation to 1) arrange for the transportation of child, whether by ambulance or otherwise, to a proper facility where emergency medical treatment would normally be administered, including but not limited to, an emergency room of a hospital, a doctor's office, or a medical clinic and 2) sign releases as may be required in order to obtain any medical or surgical treatment as is required in the judgement of medical authorities at the facility. This authorization for emergency medical treatment is valid until revoked. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Parent 1 Name (Last, First) *

Parent 2 Name or Emergency/Notification Contact (Last, First) *

Parent 1 Email *

Parent 2 or Emergency/Notification Contact Email

Parent 1 Phone *

Parent 2 or Emergency/Notification Contact Phone

Such consideration shall be for bus transportation of Child to and from Paul Revere, by Tumbleweed Transportation or a vendor chosen by PRMS Student Services, Inc. (“BusCompany”). Parents understand that the Program is solely a parent-sponsored undertaking and is intended to provide the school community with an additional choice of school transportation. Parents further understand that neither the Los Angeles Unified SchoolDistrict (“LAUSD”) nor Paul Revere Middle School operate, manage, administer or is otherwise responsible for the Program. No administrator of Paul Revere Charter Middle School or LAUSD has decision making authority. PRMS Student Services, Inc. is solely responsible for this Program. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

The Program will provide transportation in the mornings, from designated bus stops to Paul Revere, and after school from Paul Revere to designated bus stops. The proposed pick-up/drop-off stops and times are can be found at www.PaulRevereMS.com/Buses. Parents understand that the route times are estimates only, that actual times may differ sometimes due to changing circumstances (i.e., weather, traffic), and that the scheduled times and stop locations are within the sole control of Bus Company. Notice of any time or location changes shall be provided to Parents by email as soon as reasonably possible before they take effect. Parents understand they are to regularly check their email for such changes. Changes are not anticipated to occur once the school year begins, but times and designated bus stops are subject to change at the Program’s sole discretion. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Buses must keep to their route schedule in order to get children to school and home on time. Therefore, parents acknowledge that buses will not wait for late arrivals, and that they are solely responsible for making alternate transportation arrangements for their Child who arrives late to a bus departure stop, and/or otherwise misses the bus on any given day. If Parents believe Child will miss a departure designation time, he or she may take the bus from another designated departure bus stop on your route, provided that Child arrives at the other bus stop within the time limits and parameters provided for herein. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Child shall be at the morning bus stop with their parents or other designated responsible adult, no later than five minutes prior to the designated bus departure time. Child may not be left unattended under any circumstances while waiting for the bus. Parents or their designated adult are entirely responsible for Child until the bus departs. Child must behave properly while waiting. Neighbors and their properties should be respected, and Parents will be held responsible for any damages caused by Child to neighbors at the location stops. For the after-school route, Child shall be dropped off at designated stops and Parents are solely responsible for ensuring that Child gets home safely. Bus drivers will not wait for Child to be picked up by Parents or anyone else from an after-school bus stop. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Parents and Child shall never interfere with a bus driver, block a bus to prevent departure, or otherwise cause the bus to stop once the doors are closed. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Parents acknowledge and agree that Child will treat the bus drivers and all other riders with respect, shall abide normal rules of good behavior, by any and all rules of the Program, and the Bus Company provided for by the drivers and the Program, including those rules provided for and annexed as Bus Behavior Expectations in Section 2 (collectively, the “Bus Rules”), which may change from time to time at the sole discretion of the Program. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Disruptive behavior and/or violation of the Bus Rules by Child shall be grounds for suspension or expulsion from the Program, without refund of any kind. For the safety and security of all children in the program and the children who attend schools that the Bus Company uses for bus pick up and drop off, Paul Revere Middle School students may not enter other school campuses (except the school office in an emergency). All decisions concerning violation of Bus Rules, and suspension or expulsion, shall be made by officers of the Program’s (the “Committee”) or others designated by the Program from time to time. The decisions shall be final. No administrator of Paul Revere Charter Middle School or LAUSD has decision making authority. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

In the event that the school year is longer than the Program Term, Parents understand that they shall provide their own school transportation for Child. In the event that additional bus transportation can be provided, the Committee shall provide Parents with a proposed amendment to this Agreement with the additional consideration and terms for that transportation. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

Further, if Bus Company ceases to provide bus transportation before the end of the Program, the Committee shall attempt to search for replacement transportation. In such event, a partial refund of the Consideration, consisting of the amount paid to Bus Company for its services (and less administrative fees and credit card fees), shall be made to Parents if and only if this money is collected from Bus Company. No refund will be made if bus transportation is cancelled because of a strike, lockout, law enforcement direction, traffic or weather conditions, or force majeure, unless the Program receives a refund, and then a proportionate allocation shall be made to the Parent, in the Programs sole discretion. Similarly, no refund of any kind shall be made if Child ceases to attend Paul Revere for any reason during theProgram Term. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

Required

The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. By selecting that you agree to questions presented in this acknowledgement agreement, Parents agree that they have discussed the terms of this agreement and the Bus Rules with their Child, and are satisfied that Child understands them as well. Any other adult who will be taking Child or picking up Child from the bus stops, must also provide their name and agree to acknowledge they have read and understand it and the Program terms. As part of the Program, Parents shall also fill out and sign the Bus Behavior Expectation Form in Section 2. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

I wish to opt-out of signing this agreement electronically, and will fill out the forms manually which can be found at www.PaulRevereMS.com/buses. I understand that a seat will not be reserved for my child until all required forms have been received by PRMS Student Services, Inc.

Required

Questions about the Program may be emailed to: Buses@PaulRevereMS.com. BY OUR EXECUTION BELOW, WE DO HEREBY EXEMPT AND RELEASE LAUSD, PAUL REVERE CHARTER MIDDLE SCHOOL, PRMS STUDENT SERVICES, INC., IT’S DIRECTORS, THE TRANSPORTATION COMMITTEE AND EACH COMMITTEE MEMBER, AND ANY OTHER PERSON ASSISTING IN THE ORGANIZATION OF THE PROGRAM, INCLUDING THEIR AGENTS, REPRESENTATIVES, SUBSIDIARIES OR AFFILIATES (COLLECTIVELY, THE “RELEASED PARTIES”), FROM ANY AND ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, INCLUDING NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. THE UNDERSIGNED FURTHER AGREE THAT ANY DISPUTE CONCERNING THE PROGRAM, EXCEPT THOSE THAT QUALIFY FOR SMALL CLAIMS COURT, SHALL BE RESOLVED IN PRIVATE ARBITRATION, UNDER CALIFORNIA LAW, IN LOS ANGELES,CALIFORNIA, THROUGH THE AMERICAN ARBITRATION ASSOCIATION (“AAA”). IN THE EVENT OF AN ACTION OR PROCEEDING THROUGH THE AAA, THE PREVAILING PARTY SHALL BE ENTITLED TO RECOVER ATTORNEYS’ FEES AND COSTS, INCLUDING COSTS ON APPEAL. *

Yes, all parties acknowledge, understand and agree to terms using the electronic signature on this agreement.

I wish to opt-out of signing this agreement electronically, and will fill out the forms manually which can be requested by email to Buses@PaulRevereMS.com. I understand that a seat will not be reserved for my child until all required forms have been received by PRMS Student Services, Inc.

Required

Date Elecontronic Signatures Executed *

YYYY

Parent 1 Electronic Signature *

Parent 2 or Designated Adult Electronic Signature *

Designated Adult Electronic Signature *

Student Electronic Signature *

Your registration is not complete until you select "NEXT" and continue to section 2 and review the Bus Behavior Expectations with your child. *

Yes, all parties acknowledge, understand and agree to terms of the Bus Behavior Expectations using the electronic signature on this agreement.

Required

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