Please complete this registration form to arrange for transportation service All information you provide will be kept confidential. Each request will be processed promptly and you will receive a phone call to finalize any details and to let you know how we can accommodate your request. We welcome your questions and comments at any time, as well as the chance to meet you and your child. Feel free to come by and check out our shuttles. We want you to feel comfortable with your decision to use New Mexico Kids Transport for your precious cargo. Thanks for your business!!!

Personal Details
Your email:	*
Parent(s) Name:	*
Street Address:	*
City:	*
Subdivision:
Zip/Postal Code:	*
Home Phone:
Work Phone:
Cell Phone:
How did you hear about us?	superpages.com yellowpages.com craigslist.com newspaper magazine flyer business card employee current customer school saw shuttle driving found on internet HOA website Other
Name of referral:	please specify the employee, customer, newspaper magazine, homeowners association or search engine so we may credit participants in our referral program
Child's Information
Child's Name:	*
Use the address from above:
Street Address:	*
City:	*
Subdivision:
Zip/Postal Code:	*
Medical Conditions
Known Allergies
Booster seat needed?	No Yes
Required Text Messaging Information
We provide notification of your child's location by text messaging. Please provide a mobile phone or cell phone number where you can receive these alerts.
Cell phone for Notifications	*
Trip / Reservation Information
Start service date
Days needed
AM     M   T   W   T   F
PM     M   T   W   T   F
Trip Origin Daycare Child's home Parent's employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Approximate pickup time:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Origin name and address information (not needed if home address)
Enter origin name and address. For example, Grandma's house at 13 Dunbarton Ln, Denton
Contact at this origin point
Contact's telephone
Destination 1 Daycare Child's home Parent's employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Must be picked up by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Delivered to destination by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Destination name and address information
Enter destination name and address. For example, Primrose Daycare at 1212 15th Street, Denton
Contact at this destination
Contact's telephone
Destination 2 Daycare Child’s home Parent’s employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Must be picked up by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Delivered to destination by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Destination name and address information
Enter destination name and address. For example, House of Tae Kwan Doh, 332 Pearl St, Denton
Contact at this destination
Contact's telephone
Destination 3 Daycare Child’s home Parent’s employment Kindergarten thru 5th 6th thru 9th Private School After School Program Home of Relative/Friend Social Function Educational Function
Must be picked up by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Delivered to destination by:	0 1 2 3 4 5 6 7 8 9 10 11 12 00 15 30 45 AM PM
Destination name and address information
Enter destination name and address. For example, Grandma's House, 2121 Mulberry Lane, Denton
Contact at this destination
Contact's telephone
I agree to follow the guidelines as outlined in the polices and fares pages.  I understand that my child WILL NOT be transported without first signing a General Terms and Conditions Document.    We cannot schedule service unless you agree to the terms and conditions.