Transportation Contract

We provide pick-up and drop-off bus service at selected centralized locations only.

Parent Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Transportation Fees

Round Trip One Way
$2,850 $2,500 (First Child)
$1,725 $1,550 (Each Additional Child)

Oldest Child's Name *
First
Last

Transportation service for oldest child *

Do you have a second child who will be riding the bus? *
Yes
No

Second Oldest Child's Name *
First
Last

Transportation service for second oldest child *

Do you have a third child who will be riding the bus? *
Yes
No

Third Oldest Child's Name *
First
Last

Transportation service for third oldest child *

Do you have a fourth child who will be riding the bus? *
Yes
No

Fourth Oldest Child's Name *
First
Last

Transportation service for fourth oldest child *

I/we, the undersigned, desire to arrange for transportation for the above-named child(ren) as indicated. We will be contacted as to pick up and drop off times, as well as the closest centralized location, and understand that while every effort is made to minimize the time spent on the bus, the farther distances necessarily require longer transportation time. A 10% deposit is due with this signed contract and the balance is due by September 1. *
We (I) agree.

I/we understand that misconduct/misbehavior by my/our child(ren) on the bus or at the bus stop is grounds for temporary or permanent dismissal from the Loudoun Country Day School transportation system at the discretion of the Headmaster. *
We (I) agree.

Full name of person completing this form *
First
Last

Phone number of person completing this form *

Email address of person completing this form *

Deposit Total
The total amount paid with this contract is 10% of the final cost of your requested transportation services. The balance is due September 1.
$ 0.00

Clicking the "Submit" button below will submit your transportation contract and take you to our electronic payment service.