PARKING APPLICATION
Office of the Deputy Superintendent for Instruction
MONTGOMERY COUNTY PUBLIC SCHOOLS
Rockville, Maryland 20850
PARENT REQUEST FOR STUDENT USE OF PRIVATE VEHICLE
WINSTON CHURCHILL HIGH SCHOOL
Student___________________________________________________Birthdate_____________Grade______
Last
First
Address:_________________________________________________________________________________
Phone: Home_______________Emergency________________Driver’s License:_______________________
Make of Vehicle
Model & Year
_____________
State and
License Tag #
____________
Color
Name of Insurance Co.
Name of Legal Owner
________
____________________
__________________
I hereby request permission for the above-named student to drive a private vehicle to school. I understand
that parking is a privilege, not a right. Upon approval of this request, there is a non-refundable fee of $75.00
per car for the entire school year, payable to Winston Churchill High School. Lost/stolen permit replacement
will be $25.00. All parking areas are governed by the rules of Winston Churchill High School and MCPS.
If privileges are revoked the parking fees are also forfeited. I further understand that the owners or
operators of vehicles might incur certain legal responsibilities when other persons are transported as
passengers. To avoid the risk of being towed I understand that the school permit must be displayed and
visible at all times. The towing fees are regulated in Montgomery County.
The normal towing fee is $180.00 CASH ONLY.
Parent/Guardian
Home Address_____________________________________________Phone_______________
(if different from student)
Parent/Guardian
Business Address___________________________________________Phone________________
Parking permits are not transferable. I understand that violation of ANY school regulations,
and specifically regulations governing driving or parking may cause revocation of this privilege.
______________________
Signature, Parent/Guardian
__________
Date
____________________
Signature, Student
Parking Space Number Assigned____________________
Fee Paid
___________Check #
Parking Permit Number________________
______________ Cash
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____________
Date
Parking Application-Side 2
I understand that this parking permit comes with responsibilities and the following
requirements must be met to keep this parking permit throughout the year.
 I understand that forfeiture of this parking pass is a possible consequence for violating
any school rules or expectations as listed in the Parent and Student Handbook.
 If I am chronically tardy or absent, I understand my permit may be revoked without
refund of fee.
 If I am speeding or driving recklessly in the community or on school grounds my permit
will be revoked without refund of fee.
 If my permit is found in use but not in the vehicle it is registered with, I understand the
permit will be forfeited without refund of fees and vehicle may be towed at owner’s
expense and risk.
 I also understand that if I am driving in a method that is rude to community members,
by honking in parking lots at parents picking up other students, or shouting at other
parents or students, my parking privilege will be revoked without refund of fee.
 I understand parking on Winston Churchill HS property and immediate vicinity is a
privilege.
By signing, I acknowledge my understanding and agreement with all of the rules and regulations
for obtaining and holding a Winston Churchill High School Parking Permit.
________________________________________________
Student signature/date
_________________________________________________
Parent signature/date
Complete both sides
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