CAROUSEL KIDS

Transportation Agreement
This is to certify that I give Carousel Kids, Inc. permission to transport my child,
_________________________________________ from Carousel Kids, Inc. located at:
Name of Child

885 New Hope Rd., Lawreceville, GA 30046

at _________________________ (am/pm) to ___________________________________________________

Delivery Location Name and Full Address

________________________________________________________________________________________
at _________________________ (am/pm) on the following days: (Circle all that apply).
Monday

Tuesday

Wednesday

Thursday

Friday

Upon return, my child will be transported from ___________________________________________________

Pickup Location Name and Full Address

________________________________________________________________________________________
at_________________________ (am/pm) to Carousel Kids, Inc. located at:
885 New Hope Rd., Lawrenceville, GA 30046

at_________________________ (am/pm) on the following days: (Circle all that apply).

Monday

Tuesday

Wednesday

Thursday

Friday

A Carousel Kids staff member is authorized to receive my child. In the event that the above member is not
present to receive my child, the following procedures are to be followed:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

_____________________________________ is approximately ____________ miles from the center.

Name of Childs School

In the event that my child is not to be transported as outlined above, I agree to notify Carousel Kids.

Signature (Parent/Guardian) _____________________________________

Date: _____________