605.624.4419 sesdac@sesdac.org

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Youth Information Sheet

Child Information

Gender* MaleFemale

Parent Information

Day Care Information

If origin or destination is a daycare, a PARENT/DAY CARE PROVIDER SIGNOFF will need to be completed prior to beginning service.

Days*
MondayTuesdayWednesdayThursdayFriday

One-way tripRound-trip

Emergency Contacts

List of people the child can be left with if you or your daycare provider are not available:

Please read and sign

FARES: Call 605-624-7433 to purchase over the phone. Options: $2.50 for a pre-scheduled ride; $5 for a same day ride; $90 for a Jr. VIP Pass (4 yrs. or under); $50 for a punch card or $75 for a VIP Pass. Drivers will hand out the passes the first day of service.

I, the parent or guardian, agree to allow Vermillion Public Transit provide transportation for my child. I will notify Vermillion Public Transit as soon as possible of any scheduling changes or cancellations. I have reviewed the VPT Passenger Handbook.