Transportation Inner Force

Example

For More Information Call: 718-221-1246 • Enroll for Our Fall Program Today

We pick up your child from most locations and can assist you with transportation arrangements if your child's home is outside of our area. We are unique in our ability to provide transportation for our children to make our parent's lives less stressful, given their busy schedules. Also, our aftercare program is conveniently in multiple locations in Brooklyn, New York.

Transportation is available for eligible students on a first-come, first-served basis. Pick-ups and drop-offs are authorized only at the locations provided at the time of enrollment. Alternate locations must be requested and approved in writing.

ccc

Any pertinent information you would like us to know about your about your child Please Explain

I hereby grant permission to Inner Force to have my child complete a medical evaluation and complete a diagnostic evaluation using the Brigance Early Childhood Inventory Scale.

Required

Medical Evaluation

Diagnostic Evaluation

Please list any medications that your child is currently taking: Medications

Required

Insurance Company Company

Required

Policy No. Number

Required

Home Address Enter Address

Required

City Enter City

Required

State Enter State

Required

Zip code Enter Zip

Required

Last Parent Last Name

Required

Submitting Form...

The server encountered an error.

Part 2 of the Form received.

Home

Round Trip

I will Make arrangement to pick my child up

Cell Phone Enter Phone Number

Required

Home Phone Enter Phone Number

Required

Emergency Number Enter Phone Number

Required

Email address to let you know your Child was picked up an dropped off Email

Required

First Parent First Name

Required

Pick Up

At Door

At Curb

Child

Does the person we are picking up your child speak
a foreign language? c

Required

Relationship to Child Relationship

Required

Check all that apply

Allergies

Respiratory Illness

Food Allergy

Asthma

Physical Disability

Cognitive Delay

IEP

First Name Enter Text

Required

Last Name Enter Text

Required

Email Enter Text

Required

I hereby authorize in the case of emergency Inner Force or any of its personnel to obtain first aid or medical treatment for my child. I understand I cannot hold Inner Force responsible for any liability.

Required

I agree

I don't agree, just please contact me

Infant

From whom are we picking them up

From:

Pick Up Location Information

Transportation

Medical & Diagnostic Evaluation Consent