GATE PASS STICKER (VEHICLE) APPLICATION FORM (2008-2009) by axu10828

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									                                                                                                    Sticker Number (sy08-09):
                   GATE PASS STICKER (VEHICLE)
                   APPLICATION FORM (2008-2009)
                                                                                      ( )                Type of Application ( )
                        Parent/Guardian of student/s
                                                                                                   RENEWAL
                        Authorized Family Driver                                                      (OLD STICKER #):



Category
                        PTA / Alumni Officer
                        Concessionaire / Supplier
                                                                                                   NEW APPLICATION
                        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                    3) photocopy of OR
                                       2) photocopy of CR                                   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               _______________________________________               ________________________________________
& Grade / Year Level: _______________________________________                         ________________________________________
(for parent- applicants
-List all student-passengers)   _______________________________________               ________________________________________

Vehicle OWNER’S NAME:_____________________________________________                          Mobile Number: ____________________
Owner’s Home Address: _____________________________________________                         Ofc/Res. Tel. ______________________
DRIVER’S NAME: __________________________________________ Driver’s License No. ___________________
Car make:               ________________________ Model: ___________________ Year: __________ Color: ________
PLATE NO.:              ________________
                                                                                                   Checked by:________________
                                                                  (School’s Copy)
                                                                                                                    d.o.s.s.
                                                                 (Applicant’s Copy)


Driver’s Name: _____________________________________________ Driver’s License No. ________________
Car make:               ________________________ Model: ___________________ Year: __________ Color: ________
Plate No.:              ________________
FEES. Please pay the following amount to the Accounting Office:
FOR PARENTS, PTA & ALUMNI OFFICERS:
                  Vehicle Gross wt:                           Vehicle Gross wt:                    CARPOOL (<4 student-passengers)
Vehicle Type      Below 3100 (e.g. Sedan)                     3100 & above (e.g. Wagon, Exp, Truck Vehicle Gross wt: above 3100
                                                 (Less 25%
Amount to Pay                       200.00          for MC)            250.00                           200.00

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.         Read & Fill in the Application Form completely then sign at the back.
2.         Attach required documents and submit to the DOSS for evaluation of documents and fee assessment.
3.         Pay to Accounting Office.
4.         Claim Sticker Issuance Form @ DOSS & present to the guard at Gate 1 together with the vehicle for sticker installation.
5.         A Maximum of only four (4) car stickers will be issued to each family.
          If my application is approved, I agree to submit to the School’s schedule and guidelines on entry of vehicles on campus as follows:
1.        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.
2.        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
3.        Speed Limit within School grounds is 10 kph;
4.        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;
5.        “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;
6.        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)                                   Penalty       Violation (1st Offense)                                                 Penalty
     Fraudulent use of / tampered Car sticker                  500.00        Unsafe Loading/Unloading (mid-road)/ illegal backing                    100.00
     Over-speeding / reckless driving                          200.00        Disregarding stop signal/ traffic instructions                          100.00
     Parking in Drop off/ pick up bay                          200.00        Smoking in-campus/parking area                                          100.00
     Arrogant or discourteous driver behavior                  200.00        Spitting/ littering / smoke belching                                    50.00
     Double parking/ illegal parking/ illegal U-turn           100.00        Disregard of flag ceremony                                              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




          If my application is approved, I agree to submit to the School’s schedule and guidelines on entry of vehicles on campus as follows:
     1.   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.
     2.   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
     3.   Speed Limit within School grounds is 10 kph;
     4.   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;
     5.   “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;
     6.   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)                                   Penalty       Violation (1st Offense)                                                 Penalty
     Fraudulent use of / tampered Car sticker                  500.00        Unsafe Loading/Unloading (mid-road)/ illegal backing                    100.00
     Over-speeding / reckless driving                          200.00        Disregarding stop signal/ traffic instructions                          100.00
     Parking in Drop off/ pick up bay                          200.00        Smoking in-campus/parking area                                          100.00
     Arrogant or discourteous driver behavior                  200.00        Spitting/ littering / smoke belching                                    50.00
     Double parking/ illegal parking/ illegal U-turn           100.00        Disregard of flag ceremony                                              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

								
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