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Kruizin Kidz, LLC | Transportation and Personal Assistant Services in South Florida
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Registration Form
Parent / Guardian's Information
Parent or Guardian's Last Name
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Parent or Guardian's First Name
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Home Tel. #
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Work Tel. #
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Cell Phone #
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Email Address
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Mailing Address
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City
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State
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Zip Code
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Child's Information
Child's Last Name
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Child's First Name
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Child's Date of birth (mm/dd/yyyy)
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Child's Sex
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Male
Female
Child's School
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Grade Attending
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Region
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Child's Home Address (if different)
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City
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State
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Zip Code
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Child's Medical Conditions/Allergies
Medications
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Emergency Contact (if parent/guardian cannot be reached)
Last Name
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First Name
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Relationship to Child
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Home Tel. #
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Cell Phone #
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Other Tel. #
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PLEASE SELECT SERVICE NEEDED
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One Way (AM)
One Way (PM)
Round Trip
Late Bus (ONLY)
AM and Late Bus
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Your request for transportation will be replied to via email or telephone. To reserve your child's seat, a $100.00 registration fee with full payment of first month's transportation service should be made two weeks prior to the start of your child's school. We accept Cash, Checks, or Money Orders payable to: Kruizin Kidz, LLC.
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