BSM Transportation Form

Please note, Resurgence and Immersion is adhering to the CDC guidelines concerning COVID protocol. Students and Facilitators are required to complete health screenings and temperature checks during pick up. At the Youth Center, proper PPE and social distancing will be strongly enforced.

Email(Required)

Name of Parent/Guardian(Required)

First Last

Which program(s) are you a part of?(Required)

Resurgence Learning Labs

Immersion Learning Lab

Student's Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Student's Phone Number(Required)

Parent's Phone Number(Required)

Which days do you require transportation?(Required)

Monday

Tuesday

Wednesday

Thursday