Parking Pass Application 2020-2021

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This form is used to collect student, vehicle and insurance information as part of the parking pass application process. In addition to completing this online form, be sure to print, complete and sign the Passenger Permission form from the BPHS website and bring it with you when picking up your parking pass.

Email *

Student Last Name *

Student First Name *

Student ID Number *

Grade Level *

12th Grade

11th Grade

10th Grade

Homeroom *

Street Address *

City *

State *

Zip Code *

Main/Home Phone Number

Cell Phone/Other Number

Reason for Request *

Early Release--Dual Enrollment, Co-op, etc.

School Activities--Athletics, Band, Clubs, etc.

Work after School

Insurance Company and Policy Number *

Vehicle #1: License Plate *

Vehicle #1 Year/Make/Model *

Vehicle #1 Color *

Vehicle #2 License Plate

Vehicle #2 Year/Make/Model

Vehicle #2 Color

Vehicle #3 License Plate

Vehicle #3 Year/Make/Model

Vehicle #3 Color

I have read, understand and agree with the terms and conditions of parking at Bethel Park High School and conditions contained therein. *

Agree

Required

Student Signature: Typing your name in the block serves as your signature. *

Parent Signature: Typing your name in the block serves as your signature. *

Parent Email Address *

Submit

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