CCA Bus Registration Form 2023-2024 - CCA001
TRANSPORTATION COSTS: Bus service is a non-refundable, annual agreement payable either in full or in 10 monthly installments through FACTS. The cost is $2,000 for two-way service (both AM and PM) and $1,300 for one-way service (either AM or PM only). A $500 deposit is required per student if on a monthly payment plan.
Student 1 Name:
Student 1 Grade 2023-24: K12345678
Student 2 Name:
Student 2 Grade 2023-24: K12345678
Student 3 Name:
Student 3 Grade 2023-24: K12345678
Requested Bus Stop: LeesburgStone RidgePurcellville
Check One: Two-WayOne-Way AMOne-Way PM
Select payment option: Pay in FullPay Monthly ($500 deposit required)
Father Name (Guardian):
Father Mobile Phone #:
Mother Name (Guardian):
Mother Mobile Phone #:
BUS RULES 2023-2024
Buses depart promptly at 7:00 am from the following locations:
Buses depart Cornerstone Christian Academy promptly at 3:00 pm
Below are bus rules and regulations that apply to all students riding the bus. Please review the rules with your student. For the safety of everyone, a student may be suspended from riding the bus or lose ridership without reimbursement if he/she fails to obey the rules. Parents are asked to cooperate with the driver and school officials when discipline matters are involved.
FIGHTING, PROFANE LANGUAGE AND/OR POSSESSION OF WEAPONS WILL RESULT IN IMMEDIATE LOSS OF BUS RIDERSHIP and DISCIPLINARY ACTION FROM THE SCHOOL. VANDALISM WILL RESULT IN THE IMMEDIATE LOSS OF RIDERSHIP AND WILL BE CHARGED BACK TO THE PARENT.
I agree to pay the annual bus fee in full or according to the payment schedule and understand that this bus agreement is for full-year service and is non-refundable. I further understand that my child(ren) must obey all bus and school rules while riding the bus.
I also understand that use of the bus service is voluntary. I am aware of and assume the risks of travelling on the road and my student interacting with other individuals on the bus. I, for myself and on behalf of my student(s), heirs, assigns, personal representatives and next of kin, hereby assume such risks as well as voluntarily release, forever discharge, and agree to indemnify and hold harmless Cornerstone Christian Academy, their officers, officials, agents and/or employees, other participants, and any parent or subsidiary entity of the Academy (collectively the “Academy Parties”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to my participation in the Application and travel in connection with Application.
I have read and explained the above rules to my student and we both agree to always abide by them.
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Document Name: CCA Bus Registration Form 2023-2024 - CCA001
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