EmailMe Form - Parry Sound Student Carpool Matching

Name: *
First Last
Email: *
Phone: *
### - ### - ####
Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Program Area:
Days of the week you can provide transportation: *
Monday
Tuesday
Wednesday
Thursday
Friday
Available carpooling times each day: *

Monday

Tuesday

Wednesday

Thursday

Friday
Number of seats/passengers you are willing to take?
Indicate preferences:
Smoking okay?
Yes
No
Music okay?
Yes
No
Food okay?
Yes
No
Drinks okay?
Yes
No
Talking okay?
Yes
No
Coffee stop okay?
Yes
No
Daycare/school stop okay?
Yes
No
Gas station stop okay?
Yes
No
Grocery store stop okay?
Yes
No
Phone calls / video calls okay?
Yes
No
Acknowledgement of driver’s license and insurance that covers carpooling (we recommend at least $2,000,000 in liability insurance)
Yes?
Students should share their schedules and contact information with each other once matched.

NOTE: Please fill out passenger form if you would like to share the driving.
Do you agree to the terms of using this matching service?

By selecting yes, you acknowledge that your personal information will be used solely for the purpose of facilitating carpooling arrangements and agree to sharing your personal information with any matches. You acknowledge that the college is not liable for any problems that may arise from carpooling arrangements. *
Yes
No