CAMPUS SAFETY DEPARTMENT

VEHICLE PERMIT NUMBER: ______

VEHICLE REGISTRATION FORM

All motor vehicles that are driven or parked on campus must be registered. For each vehicle that is registered, the driver will be issued a Kuyper College vehicle parking permit. The twenty dollar ($20.00) vehicle/parking fee is included within the Annual Student Life Fee and has already been charged to your account. Please note that there will be a $20 replacement fee should you lose your parking permit.

To register your vehicle(s) and receive your vehicle permit(s), a completed vehicle/parking registration form for each vehicle must be submitted to the Campus Safety Office prior to parking over night on campus.

FULL NAME: ______Check All That Apply

CAR MAKE: ______On-Campus Freshman

CAR MODEL: ______On-Campus Upper Classmen

VEHICLE YEAR: ______Commuter

COLOR: ______Staff/Faculty

LICENSE PLATE: ______

STATE/PROVINCE: ______

______Signature Date

****************************************************************************** ADMINISTRATIVE USE ONLY

Officer Issuing Permit ______Date ______

Entered Into Parking Permit Data Base Officer ______

Permit Returned Return Date ______