

| Name of Parent / Guardian | Phone number(s) | |
| Name of Student | Grade | Academy |
| City | Zip Code | Major Cross Streets |
| Class Schedule: | ||
| Mon. & Wed. Start Time | Mon. & Wed. End Time | |
| Tues. & Thurs. Start Time | Tues. & Thurs. End Time | |
| Special Requests |
Due to staggered schedules and the wide geographic area in which CHAMPS students reside, it is not always possible for a carpool to be arranged.
Public transportation is available at:
| METRO.net | LADOT DASH Panorama City_Van Nuys | LADOT DASH Van Nuy_Studio City |
If you can help make carpool matches, please contact the CARPOOL COORDINATOR.
Family service credit wil be provided for this volunteer activity.