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GATE PASS STICKER _VEHICLE_ APPLICATION FORM _2008-2009_

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					GATE PASS STICKER (VEHICLE) APPLICATION FORM (2008-2009)
( )

Sticker Number (sy08-09):

Type of Application ( )

Parent/Guardian of student/s Authorized Family Driver Category PTA / Alumni Officer Concessionaire / Supplier Commercial Transport Service / V-Hire / Bus School Personnel Other:
Please attach the following to this application form: NEW APPLICATION : 1) copy of Student Admission Slip 2) photocopy of CR

RENEWAL
(OLD STICKER #):

NEW APPLICATION

3) photocopy of OR 4) payment receipt

RENEWAL

:

1) photocopy of CURRENT LTO official receipt (OR) for registration 2) payment receipt

COMMERCIAL TRANSPORT PROVIDERS (commercial carpools, v-hire, bus): 1) Application Form (CTS) 4) List of Passengers & Service 2) Driver’s Biodata Sheet Contracts 3) Copy of Driver’s License, OR/CR 5) payment receipt Kindly read the guidelines at the back of this page and affix your signature on the space provided. Thank you.

NAME OF STUDENT/S
(for parent- applicants -List all student-passengers)

_______________________________________

________________________________________ ________________________________________ ________________________________________ Mobile Number: ____________________ Ofc/Res. Tel. ______________________

& Grade / Year Level: _______________________________________ _______________________________________

Vehicle OWNER’S NAME:_____________________________________________
Owner’s Home Address: _____________________________________________

DRIVER’S NAME: __________________________________________ Driver’s License No. ___________________ Car make: PLATE NO.: ________________________ Model: ___________________ Year: __________ Color: ________ ________________
Checked by:________________
(School’s Copy) (Applicant’s Copy)

d.o.s.s.

Driver’s Name: _____________________________________________ Driver’s License No. ________________ Car make: Plate No.: ________________________ Model: ___________________ Year: __________ Color: ________ ________________

FEES. Please pay the following amount to the Accounting Office: FOR PARENTS, PTA & ALUMNI OFFICERS: Vehicle Gross wt: Vehicle Type Below 3100 (e.g. Sedan)
Amount to Pay

Vehicle Gross wt: CARPOOL (<4 student-passengers) 3100 & above (e.g. Wagon, Exp, Truck Vehicle Gross wt: above 3100 250.00 200.00

200.00

(Less 25% for MC)

FOR CONCESSIONAIRES, REGULAR SUPPLIERS, COMMERCIAL TRANSPORT PROVIDERS: All Vehicle Types

250.00

Proceeds from sticker fees & traffic fines are used for the following: a) honoraria of Traffic aides/tanods and purchase of traffic paraphernalia; b) provision of traffic & safety signs, barriers, and other devices; c) painting of roads, lanes & gutters; d) other expenses related to School traffic management & pedestrian safety.

PROCEDURES & GUIDELINES for Application:
1. 2. 3. 4.
5.

Read & Fill in the Application Form completely then sign at the back. Attach required documents and submit to the DOSS for evaluation of documents and fee assessment. Pay to Accounting Office. Claim Sticker Issuance Form @ DOSS & present to the guard at Gate 1 together with the vehicle for sticker installation. A Maximum of only four (4) car stickers will be issued to each family.

1. 2. 3. 4. 5. 6.

If my application is approved, I agree to submit to the School’s schedule and guidelines on entry of vehicles on campus as follows: Only vehicles with valid Car Pass Stickers will be allowed entry on campus (“No sticker, No entry”); The School reserves the right to cancel the privilege of vehicle entry on campus for repeated or serious violations of traffic & safety regulations. Entry on campus is only during the following drop off & pick up schedules: 6:00 - 7:45AM and 2:00 - 5:30PM during class days; during Card Distribution & announced School Activities; appointments Speed Limit within School grounds is 10 kph; Vehicles are subject to searches/inspection before allowed entry or upon request by security personnel; Keep front windows of vehicles open when entering the School gate; “Drop off and go or pick up and go” arrangement in the designated drop off/pick up areas or pocket lanes should be observed. Waiting and loading/unloading time should not exceed one (1) minute for private vehicles; Penalties/fines and/or sanctions will be imposed for traffic/parking violations. Serious violations will be referred to TEAM & Traffic-PNP on top of permanent disbarment from school premises as a consequence.
Violation (1st Offense)
Fraudulent use of / tampered Car sticker Over-speeding / reckless driving Parking in Drop off/ pick up bay Arrogant or discourteous driver behavior Double parking/ illegal parking/ illegal U-turn

Penalty
500.00 200.00 200.00 200.00 100.00

Violation (1st Offense)
Unsafe Loading/Unloading (mid-road)/ illegal backing Disregarding stop signal/ traffic instructions Smoking in-campus/parking area Spitting/ littering / smoke belching Disregard of flag ceremony

Penalty
100.00 100.00 100.00 50.00 50.00

7.

Parking is allowed only on designated parking areas (graveled parking area; designated road-sides during pick up); No abandoning of vehicles is allowed on the drop off/pick up bays or pocket lanes. No parking on the drop off /pick up bays; pedestrian lanes (brick road); side-walk and on reserved areas. Furthermore, I will also ensure the following: that no student is allowed to drive my vehicle and only an adult-driver with a valid license shall operate it; that the driver using my car does not drink intoxicating liquor or engage in inappropriate behavior (smoking, gambling, rude conduct) on campus; that the gate pass sticker is attached to the driver’s side of the lower-front windshield of my vehicle with full knowledge that the gate pass sticker is NON-TRANSFERABLE and specifically for the vehicle described herein. that the School Security Services is notified ASAP of: a) change in license plate number; b) change in vehicle ownership, & c) vehicle-make alteration.

8. 9. 10. 11.

I understand that my vehicle is my responsibility even when inside the School premises. I will not hold the School or any of its personnel liable for any damage to my vehicle or for loss of any item left inside during circumstances beyond the School’s diligence and control. I also understand that when inside School campus, visits to the Classrooms, Faculty Rooms and Offices without prior appointments or approval are prohibited in order to avoid disruption of the teaching process and School operations. I will observe the “No Loitering, No Littering” rule. I further bind myself to be severally liable for any untoward incident that may arise involving my vehicle when inside the School zone.
_____________________________________________________ PRINTED NAME & SIGNATURE OF VEHICLE OWNER __________________________ CELLPHONE NUMBER __________________ Date

1. 2. 3. 4. 5. 6.

If my application is approved, I agree to submit to the School’s schedule and guidelines on entry of vehicles on campus as follows: Only vehicles with valid Car Pass Stickers will be allowed entry on campus (“No sticker, No entry”); The School reserves the right to cancel the privilege of vehicle entry on campus for repeated or serious violations of traffic & safety regulations. Entry on campus is only during the following drop off & pick up schedules: 6:00 - 7:45AM and 2:00 - 5:30PM during class days; during Card Distribution & announced School Activities; appointments Speed Limit within School grounds is 10 kph; Vehicles are subject to searches/inspection before allowed entry or upon request by security personnel; Keep front windows of vehicles open when entering the School gate; “Drop off and go or pick up and go” arrangement in the designated drop off/pick up areas or pocket lanes should be observed. Waiting and loading/unloading time should not exceed one (1) minute for private vehicles; Penalties/fines and/or sanctions will be imposed for traffic/parking violations. Serious violations will be referred to TEAM & Traffic-PNP on top of permanent disbarment from school premises as a consequence.
Penalty
500.00 200.00 200.00 200.00 100.00

Violation (1st Offense)
Fraudulent use of / tampered Car sticker Over-speeding / reckless driving Parking in Drop off/ pick up bay Arrogant or discourteous driver behavior Double parking/ illegal parking/ illegal U-turn

Violation (1st Offense)
Unsafe Loading/Unloading (mid-road)/ illegal backing Disregarding stop signal/ traffic instructions Smoking in-campus/parking area Spitting/ littering / smoke belching Disregard of flag ceremony

Penalty
100.00 100.00 100.00 50.00 50.00

7.

Parking is allowed only on designated parking areas (graveled parking area; designated road-sides during pick up); No abandoning of vehicles is allowed on the drop off/pick up bays or pocket lanes. No parking on the drop off /pick up bays; pedestrian lanes (brick road); side-walk and on reserved areas.

Furthermore, I will also ensure the following: 8. that no student is allowed to drive my vehicle and only an adult-driver with a valid license shall operate it; 9. that the driver using my car does not drink intoxicating liquor or engage in inappropriate behavior (smoking, gambling, rude conduct) on campus; 10. that the gate pass sticker is attached to the driver’s side of the lower-front windshield of my vehicle with full knowledge that the gate pass sticker is NON-TRANSFERABLE and specifically for the vehicle described herein. 11. that the School Security Services is notified ASAP of: a) change in license plate number; b) change in vehicle ownership, & c) vehicle-make alteration. I understand that my vehicle is my responsibility even when inside the School premises. I will not hold the School or any of its personnel liable for any damage to my vehicle or for loss of any item left inside during circumstances beyond the School’s diligence and control. I also understand that when inside School campus, visits to the Classrooms, Faculty Rooms and Offices without prior appointments or approval are prohibited in order to avoid disruption of the teaching process and School operations. I will observe the “No Loitering, No Littering” rule. I further bind myself to be severally liable for any untoward incident that may arise involving my vehicle when inside the School zone.
_____________________________________________________ PRINTED NAME & SIGNATURE OF VEHICLE OWNER __________________________ CELLPHONE NUMBER __________________ Date