Student Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Consent To Parking Rules *

In acceptance of my parking permit I acknowledge that I will follow the rules as described below and that failure to comply with the rules may result in my permit being confiscated and my parking privileges being revoked. I acknowledge that should my privileges be revoked due to rule violations that there will be no refund for the cost of the permit and I will not be allowed to reapply for a permit until the next school year. Parking permits will be only valid from the 3 rd Monday in August till the 1 st Friday in June. Vehicles must park between the lines in a proper manner and must park head-in first. Student Parking is limited to the 4 rows of parking closest to the southern pond and all other parking is retained for the exclusive use of all the tenants and guests of 2244 W 95th Street building. There is a 5 MPH speed limit in the lot and any reckless driving shall result in immediate revocation of parking privileges. There is no littering or loitering in the parking lot. No vehicles with weapons, alcohol, drugs, and/or drag paraphernalia are allowed on the lot at any time. No sharing of permits or moving from vehicle to vehicle. If you drive a new vehicle mid-year you must notify us to update auto information and request a new sticker. By signing below, the student agrees to abide by all rules written above:

I Agree

I Disagree

Date *

MM

DD

YYYY

Parent Name *

First Name

Last Name