Transport Request Form

PARENTS OR GUARDIANS

Please complete this form if you would like your child/ren transported by car during a Leor session of care.

Transport Request Form

Your Name*
First Last
Your Email*
Your Child/ren's name/s*
Your Transportation Requirements*
Is the child/ren 4yrs or over?*
- Yes
- No
Please note that the Educator can not transport the child/ren and a family vehicle will need to be supplied if transport is needed.
Do your children use any of the following:*
- Baby Capsule
- Children's Car Seat (under 7 years and < 145cm)
- Booster Seat
- None of the above
Please complete the following:*
- I authorise Leor Staff to drive my vehicle
- I have comprehensive car insurance for my vehicle covering all drivers
- I authorise Leor Staff to transport my child/ren in their vehicle
- I accept the safety and roadworthiness of the Leor Staff member's vehicle
- I will sight the Leor Staff member's driver's licence
Transportation Charges*
- I accept the transportation charges of $2.00 per kilometre for the mileage incurred by the Educator, as outlined in my Leor contract.
Please upload a copy of your comprehensive car insurance*
Drop files here or
Please upload photos of the installed car seats*
Drop files here or
Signature

Save and Continue Later

Phone: 02 9051 0511
Email: learn@leor.com.au

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