AUTOMOBILE RULES & APPLICATION - Park City High School ...

2011-2012
Application for PCHS Parking Permit
Each vehicle to be used by a student must be listed on this registration form. All information requested
must be provided in the spaces indicated. Only immediate family vehicles may be registered. If and when
information changes, the student must update the information with the Main Office.
Student Name: __________________________________________________
(Please print)
Grade 10 11 12 (circle one)
Driver License # _____________________
Vehicle #1
Make: ________________________
Color: ________________________
Model: _______________________
Plate # _______________________
Vehicle #2
Make: ________________________
Color: ________________________
Model: _______________________
Plate # _______________________
Vehicle #3
Make: ________________________
Color: ________________________
Model: _______________________
Plate # _______________________
I have read and understand all rules pertaining to parking on PCHS grounds. And agree to abide by these
rules for the school year.
Student Signature: ___________________________________________ Date: _______________
I being the parent/guardian of the above student acknowledge that I have read and support the rules for
parking on school grounds and confirm the information provided is correct.
Parent/Guardian Signature: ____________________________________ Date: _______________
FOR OFFICE USE ONLY:
Parking permit # ____________________
Check # ___________________
Cash _____________
Received by: ______________________
Date Received: _______________________