Carpool Registration - Chabad Wilshire Corridor

Carpool Sign-Up Form
We're happy to offer a convenient carpool option for our families. Carpool runs every Hebrew School Tuesday, September through May. Please complete one form per child you're signing up.
How Carpool Works
Each Tuesday, an independent, professional car service picks the children up from Warner Avenue School and brings them to Wilshire Hebrew School at 741 Gayley Avenue. A Hebrew School staff member escorts the children from school into the car service vehicles and makes sure they're safely buckled in. When they arrive, Hebrew School staff greet the children and help them out of the car.

Please follow the routine for your child's grade:
- Grades 2 and above: Students wait with their backpacks at the Rainbow Wildcats Bench in the main yard. (See photo below.)
- Grades 1 and below: Children are picked up directly from their classrooms.
- Please add our Hebrew School staff member as an emergency contact and notify the teacher by email, which authorizes us to sign your child out on your behalf.
- Please review this routine with your child so they know what to expect.
The Rainbow Wildcats Bench, this is where students go when dismissed to wait for the teacher.
Parent/Guardian Information
Parent/guardian name *
First Name Last Name
Phone number*
Email*
Student Information
Child's name*
First Name Last Name
Grade*
Classroom number*
Teacher's name*
Photo upload*
Carpool Fee & Payment
Carpool is $15 per week × 27 weeks = $405 for the year.
Payment Plan:*

Pay in full by checkPay in full by credit cardPayment plan, 4 equal payments by credit card
I understand my child's place is not reserved until we receive the check. Please make the check payable to Chabad Wilshire Corridor for the full amount due ($405 for one child), and mail or drop it off to 919 Malcolm Avenue, Los Angeles, CA 90024*

Yes
Please make your check payable to Chabad Wilshire Corridor for the full amount due ($405 for one child), and mail or drop it off to 919 Malcolm Avenue, Los Angeles, CA 90024. Your child's place is reserved once we receive it.
I agree to be charged the full amount, plus a 3% credit card fee*

Yes
I agree to be charged in 4 equal monthly installments, each plus a 3% credit card fee.*

Yes
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Electronic Signature / Authorization
By submitting this form and signing below, I confirm that I am the parent or legal guardian of the child named above and that the information I have provided is accurate. I authorize a Hebrew School staff member, on behalf of Wilshire Hebrew School, to sign out and escort my child to the carpool vehicles on Tuesdays. I understand that the transportation itself is provided by an independent, professional car service, and not by Wilshire Hebrew School or Chabad of the Wilshire Corridor, which help coordinate this convenience but do not own, operate, supervise, or insure the vehicles or the driving, and make no representation or warranty regarding the drivers or vehicles. To the fullest extent permitted by law, I release and hold harmless Wilshire Hebrew School, Chabad of the Wilshire Corridor, and their directors, employees, and volunteers from any and all claims, liabilities, injuries, or damages arising from or related to the carpool and the transportation of my child. I have read and understood these terms and am signing electronically with the same effect as a handwritten signature.
*

I have read and accept these terms
Electronic Signature*
Date*

Month Day Year
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Carpool Sign-Up Form

How Carpool Works

Parent/Guardian Information

Student Information

Carpool Fee & Payment

Electronic Signature / Authorization