Greensburg Central Catholic Junior-Senior High School

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Student Parking Permit Application

Qty

Description

Amount

Total

Student Parking Permit

$30.00

Total: $30.00

Permit Information

Driver's Name: *

Grade: *

List all vehicles that will be driven during the school year.

Make: *

Model: *

Color: *

License Plate #: *

You must list all passengers in your car and all parents must sign the form. Additional passengers are only permitted with written permission from parents of driver, parents of passenger and permission from Principal.

Passenger's Name:

A copy of your current driver’s license MUST BE SCANNED AND EMAILED to Ruth Ann Grant at RGrant@gcchs.org. Your application WILL NOT be processed without this.
Display permit in vehicle AT ALL TIMES.
Park in designated areas for students.
Do not leave the parking lot after school until all buses have departed.
Do not go to your vehicle during the school day.
Remember to always lock your vehicle.

Notify the school office immediately of any vehicle or license plate changes.

FAILURE TO COMPLY WITH THE ABOVE RULES WILL RESULT IN LOSS OF DRIVING PRIVILEGES.

By typing your name below, you accept that this acts as your individual signature, and you agree that you have read and understand the rules stated in this application.

Driver's Signature: *

Date: *

Parent Signature - Driver: *

Date: *

Parent Signature - Passenger 1:

Date:

Parent Signature - Passenger 2:

Date:

Parent Signature - Passenger 3:

Date:

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

Phone number to contact in case of questions

E-mail: *

A receipt will be e-mailed to this address.

ALL MAJOR CREDIT CARDS ACCEPTED

Please Note:
You may pay with a credit or debit card at the PayPal screen even if you don't have an account.

Please click Proceed to Confirmation below to pay with a credit card on the next page. No PayPal account is required.

ENTER YOUR PAYMENT INFORMATION ON THE NEXT SCREEN

Click 'Proceed to Confirmation' to pay with PayPal on the next page.