PLEASE NOTE: To process this application, you must complete the following steps:  Fill out this form – be sure you (student) and a parent or guardian has signed front and back  Go to the Financial Office – pay the fee or get verification of free/reduced status  Bring in the following documents – Current Driver’s license, current vehicle registration, proof of current insurance on the vehicle  Contact Mr. Martinelli to obtain your parking permit

Pomona High School – Parking Permit Agreement APPLICATION FOR SCHOOL PARKING LOT ACCESS 2016-2017 I agree to the terms and responsibilities stated below and on the back of this document in connection with obtaining authorization to use the school parking lot. I understand that the parking lot is the property of Jefferson County Public Schools R-1. I agree that the car driven will not be used to transport or store illegal items on school property. I agree that I will not use the school parking lot to violate a criminal code or school rule. In exchange for the privilege of parking on school property, I give school officials and/or school security personnel consent to search the car and the car’s contents at any time when it is parked on school property. I authorize school officials and/or school security personnel to seize any item that violates a criminal law or school rule or provides evidence of a criminal law or school rule violation. I understand that violations of these rules and/or the site based rules on the back of this document can lead to suspension or revocation of my parking privileges, fines, referral to law enforcement authorities and/or school disciplinary actions.

Student’s Name ____________________________Grade_______ DOB____________ (Print)

Driver’s License #__________________ Insurance____________________________________ Address_______________________City_______________________State_____Zip_________

Vehicle Make___________Model___________Color_________Year_____License Plate____________ Vehicle Make___________Model___________Color_________Year_____License Plate____________ I, (student signature) understand and agree to the above terms and the site based terms on the back of this document 2016-2017.

(Parent)

(Student)

I, (parent signature) understand and agree to the above terms and the site based terms on the back of this document 2016-2017. Tag#_____________ *Being behind in credits may result in losing parking privileges.

SITE BASED RULES AND EXPECTATIONS 1. All vehicles driven to school must be registered with the school and the Pomona parking permit must be displayed in a location clearly visible from the outside of the vehicle. 2. Car pools are encouraged. All vehicles used in a carpool must be registered with the school. 3. Speed limit on school grounds is 10 MPH. The vehicle must be operated in a safe and legal manner at all times. 4. School parking permits are valid from 7a.m. to 3:15p.m. and are limited to the spaces delegated to students including any reserved spaces or off-limits spaces. 5. Students are not allowed to loiter in the parking lots or vehicles before, during, or after school hours. 6. A $20 fine will be assessed for each parking or moving violation committed on campus. Violations include: parking in emergency access lanes, parking in the staff parking, parking an unregistered vehicle, parking without a visible permit, parking improperly in a marked space and parking in a Handicap parking space. If you receive 3 tickets, your car will be booted. Cost to remove the boot is $75. 7. Violations of rules and expectations may lead to fines, parking boot, or towing as well as law enforcement involvement and school disciplinary consequences. 8. Students who park on school grounds must possess a valid driver’s license. To register their vehicle, students must complete this form and provide proof of valid registration and current insurance coverage. 9. Transportation of freshmen or sophomores off campus during the school day is a violation of the closed campus policy and this parking agreement. Violation may lead to the loss of parking privileges. 10. Altering, falsifying, transferring without permission a parking tag—$20.00 and possible suspension and/or revocation of parking privileges. Students have 10 school days to dispute or contest any fines. Failure to contest a fine within 10 days will lead to the imposition of the fine. All fines should be paid within 30 days and it is the student’s responsibility to communicate with parents regarding fines. Jefferson County Schools and Pomona High School assume no responsibility for any damage to vehicles parked on school property or to the loss of any articles contained therein. Acceptance of the parking permit constitutes acknowledgment by holder(s) that the above conditions have been read and understood. I have read and understand the “Parking Permit Agreement.” I clearly understand my obligations. Should I violate the provisions of this agreement, I can be asked to surrender my Parking Permit. In addition, I understand that the Fire and Police Departments may also issue tickets or have my car towed should I violate the fire lane and/or handicapped parking regulations.

Student Signature____________________________________ Date_________________

Parent Signature_____________________________________ Date_________________

Revised 5/9/16