Registration - Transport HSF

APPLICATION FORM

TRANSPORT DE PERSONNES HSF

Complete the Application Form in order to be eligible to use the Public Transportation with Reservation and/or Carpooling (option 3).

The information provided will remain confidential and exclusively for use by Transport de personnes HSF.

PERSONAL IDENTIFICATION

Type of service desired :Public transportationCarpooling

Mrs.Mr.

*First name:

*Last name:

*Address:

*Postal code:

*City:

*Phone number:

*Date of birth (aaaa/mm/jj):

For applicants who are not yet thirteen (13) years old, please send us proof of parental authorization by mail. If this document is not provided, the applicant must be accompanied by a person 18 years or older when using public transportation.

EMERGENCY CONTACT PERSON:

*First name and last name:

*Phone number:

*Relationship to the applicant:

I certify that the information provided is correct. I understand that any false declaration will cause my application to be refused or revoked. I consent to following the rules and procedures established by the public transportation entity.

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