Education United at Highview Elementary - United Way of Westchester and Putnam

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SNEAK PREVIEW at Highview Elementary

The first and last name of the parent/ primary caregiver / El nombre y apellido del padre/cuidador principal(Required)

First Last

The first and last name of the student / El nombre y apellido del estudiante(Required)

First Last

Number of Family Members Attending / Número de miembros de la familia que asisten(Required)

Please enter a number from 2 to 8.

A mobile number to receive text messages / Un número de móvil para recibir mensajes de texto.(Required)

Email address / dirección de correo electrónico(Required)

Primary language of the rider / Idioma principal del ciclista(Required)

Do you need transportation to the event? /¿Necesitas transporte al evento?(Required)

yes/si

no

Do you have a smartphone? / ¿Tienes un teléfono inteligente?

Yes / si

No

Do you have a debit card or credit card? / ¿tienes tarjeta de debito o tarjeta de credito??

Yes / si

No

Do you have a Lyft account? / ¿Tienes una cuenta de Lyft?

Yes / si

No

Address of the pickup location / Dirección del lugar de recogida(Required)

Street Address Address Line 2 City State ZIP Code

Time of pick up / hora de recogida(Required)

Hours

:

Minutes

AM/PM

Will the return trip be to the address of the pick up? / ¿El viaje de regreso será a la dirección de recogida?

Yes / sí

No / no

If yes, what address will you be going to from Highview Elementary School? / En caso afirmativo, ¿a qué dirección irá desde la Escuela Primaria Highview?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How many people will be using the ride (up to 3)? / ¿Cuántas personas usarán el viaje (hasta 3)?(Required)

Please enter a number from 1 to 3.

Is the person a veteran? / ¿Es la persona un veterano?(Required)

Age of the primary rider / Edad del viaje principal(Required)

Please enter a number from 0 to 106.

Primary reason for transportation barrier / Razón principal de la barrera del transporte(Required)

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336 Central Park Avenue
White Plains, NY 10606

914.997.6700
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