202-827-7381 or 240-608-2933 301-769-6989 info@ek4kids.com Frederick Kids Transportation

Registration Information

To register for EK4KIDS services, simply refer to the steps below. You may register online, or print the registration form and fax it in to us at 301-769-6989 or email it back to us at info@ek4kids. Please also complete and return the Credit Card Authorization form. If you prefer a Word.doc format, please email us a request, and we will email the files to you as a document. It is so simple; your children will be experiencing executive-style transportation in no time!

Step 1

You decide EK4Kids is for you. Contact us for a rate quote.

Step 2

Contact us to schedule a meeting with an EK4Kids representative at your convenience.  We want to meet you, and we are sure you would like to meet us. We come to you, at home or office.

Step 3

Go over your child’s schedule with us.

Step 4

Fill out the EK4Kids registration form and credit card form and review our policies.

Step 5

Pay the $150 registration fee for one child, or $200 for a family up to 4 kids. Prepay for the rides to begin service.

Step 6

Relax, knowing that your child is safe and having fun in our EK4Kids shuttle!

EK4KIDS ONLINE REGISTRATION FORM
Please complete form below to begin the registration process for EK4KIDS services. All fields with an * means the field is required.

PARENT INFORMATION

First Name*: Last Name*:

Relationship to passenger(s)*: Mom/Dad/Other

Your Email*:

Home Phone: Cell Phone*: Work Phone:

Home Address*: City*: State*: Zip Code*:

Work Address: City: State: Zip Code:

PASSENGER(S) INFORMATION
PASSENGER 1

First Name*: Last Name*:

Gender*: Date of Birth (mm/dd/yyyy)*: Age*:

Special Needs (medications, allergies, food allergies, etc):

PASSENGER 2

First Name: Last Name:

Gender: Date of Birth (mm/dd/yyyy): Age:

Special Needs (medications, allergies, food allergies, etc):

PASSENGER 3

First Name: Last Name:

Gender: Date of Birth (mm/dd/yyyy): Age:

Special Needs (medications, allergies, food allergies, etc):

PASSENGER 4

First Name: Last Name:

Gender: Date of Birth (mm/dd/yyyy): Age:

Special Needs (medications, allergies, food allergies, etc):

SECONDARY CONTACT: The safety and well-being of riders is our primary goal. To help achieve this, EK4KIDS asks for a Secondary Contact. This is a person who knows the rider, the details of his/her rides, and who has the authority to take action on his/her behalf, if the Primary Contact person is unavailable.

First Name*: Last Name*:

Relationship to passenger(s)*: Mom/Dad/Other

Email: Home Address*:

Home Phone: Cell Phone*: Work Phone:

TRANSPORTATION DETAILS: Please complete all 3 sections to ensure accuracy with scheduling your child’s transportation needs. Each section needs to be detailed and legible. Be sure to specify the days, dates and times that transportation will be needed, as well as any special instructions you think may be necessary or helpful:

PICK-UP INFORMATION

Pick-up Location*:  Home School

Pick-up Day(s)*: Monday Tuesday Wednesday Thursday Friday

Requested Pick-up Time*: Start Date*:

Name of School (if school):

Pick-up Address*: City*: State*: Zip*:

Please provide the name of someone at this location who will know the passenger (if not being picked up at home or school):

First Name: Last Name:

Relationship to Passenger(s): Phone Number:

DROP-OFF INFORMATION

Drop-off Location*:  Home School Other

Requested Drop-off Time*: Earliest Time*: Latest Time*:

Name of School (if school):

Drop-off Address*: City*: State*: Zip*:

Please provide the name of someone at this location who will know the passenger (if not being picked up at home or school):


Full Name:

Relationship to Passenger(s): Phone Number:

If drop-off is at home, will an adult age 22+ be home?:

If No, enter name here to authorize EK4KIDS, LLC to drop-off rider(s) and release EK4KIDS, LLC of all responsibilities and liabilities of any actions that can or may occur once rider(s) exit the EK4KIDS, LLC vehicles.

Your Full Name:

BILLING INFORMATION

If different from the Primary Contact, please enter the name of the person who is responsible for payment of EK4KIDS, LLC invoices, that is, to whom EK4KIDS, LLC should send invoices for services provided to the rider(s) names above?

Title: First Name: Last Name:

Email: Phone:

If this person works for, or represents, another entity, e.g., a group, business, school or organization, complete below.

Name of the entity:

Address: City: State: Zip:

Name of person completing this form, if NOT the same person to whom invoices should be sent: Full Name:

AUTHORIZATION

By signing below, I authorize EK4KIDS, LLC to transport the above rider/s from the place of origin to the destination listed above. I understand EK4KIDS, LLC is a prepay/scheduled service and transport will take place after payment has been received. I further acknowledge and understand that EK4KIDS, LLC responsibility for the rider/s safety and well-being starts at the point of entrance of a EK4KIDS, LLC vehicle and stops at the point of exit of the EK4KIDS, LLC vehicle.

Signature*: Date*:


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