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Concord Academy

Student Parking Permit Request Form

Parking Permits for 2018-19 will be issued during the first week of classes. Families are asked to complete this form and return to the Operations Department by June 25, 2018 (either by mail or by email to: If your child anticipates receiving a license during the academic year, this form can be filled out at that time.

STUDENT NAME________________________________________ GRADE______________

HOMETOWN__________________________________ DATE OF BIRTH________________

VEHICLE MAKE______________ MODEL_____________ YEAR_______ COLOR________

PLATE #________________________

We have read this form and the policy description in the "driving, dropping off, and parking" form and agree to all conditions. We understand that failure to abide by these policies may result in suspension of the parking permit and thus one’s ability to drive to school as well as the possibility of a disciplinary response.

PARENT SIGNATURE_______________________________________ DATE________ CELL #_________________

STUDENT SIGNATURE______________________________________ DATE________ CELL #_________________



Date Form Received:_______________________________

Student ID #:_____________________________________

Parking Permit #:__________________________________

Date of Issue:_____________________________________