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NIST SUMMER SCHOOL BUS TRANSPORT REQUEST 18 June – 13 July 2018 Montri Transport Corporation Public Company Limited Tel.: +66 (0)2 906 0160 ext. 301-304 Fax: +66 (0)2 517-9207 [email protected]

Academic Camp (9:00 AM – 1:30 PM)

Sports Camp (9:00 AM – 1:30 PM)

Starting Date

Starting Date

Child(ren)’s Details First Child’s Full Name Nickname

Year/Class

Second Child’s Full Name Nickname

Year/Class

Third Child’s Full Name Nickname

Year/Class

Family Details Parent’s Full Name

Pick-up & Dropoff Address

Contact #

Mooban (Village)/Apartment Name House/Apartment Number Soi & Sub-Soi (if applicable) Sub-District Province

Room Number Road District Zip Code

Fee Details (see zones on next page)

Zone N Zone 1 Zone 2 Zone 3 Zone 4 Zone 5 Zone 6

1 Week 1,960 2,150 2,320 2,490 2,720 2,880 3,040

2 Weeks 3,800 4,140 4,490 4,830 5,230 5,550 5,880

3 Weeks 5,650 6,090 6,600 7,120 7,690 8,180 8,660

4 Weeks 7,280 7,860 8,460 9,120 9,750 10,370 10,990

I understand that the bus fee is non-refundable and agree to make the full payment in the amount of THB ______________ to the school’s Finance & Accounting Department at least one week prior to the start of the summer school programme. Please save your receipt to show to the Montri driver before boarding the bus. Please note that by signing this document, you are agreeing to the release of liability on page 2 if your child has severe allergies.

Parent Signature

Montri Use Only Zone No. Confirmed by Date:

NIST Use Only Invoice No. Receipt No. Confirmed by

Amount Amount Date

Updated 2018 March 20

Zones Zone N

Sukhumvit 11, 13, 15, 17, 19

Zone 1

Sukhumvit 1, 3, 5, 7, 9

Zone 2

Asoke Dindang Road Ploenchit Road Rajdamri Road

Zone 3

Congnonsee, Nanglinchee Charoenkrung Road Naratiwas Road Pattanakarn 1 – 54 Phayathai Road Petchaburi Road, Pratunam

Zone 4

Sukhumvit 2 – 24 Soi Langsuan Soi Nailert Soi Ruamrudee

Sukhumvit 21 – 39

Soi Somkid Soi Tonson Sukhumvit 26 – 48

Rama 1, 3, 4, 9 Rangnam Road Ramkhamhaeng 2 – 54, 1 – 93 Ratchadapisek (Ladprao intersection) Ratchawithee 1 – 9 Sonvijai, Sathorn Road

Bangna Trad km. 1-10

Pattanakarn 53 – 69

Charoen Nakorn Road Charansanitwong Road Dusit District Is-Saraphab Road Klongsarn Krunthonburi Road

Phaholyothin 1 – Chatujak Prannok Rama 6 Rajdamnern Road Ramkhamhaeng 56 – 180, 95 – 199 Seacon - Suanluang

Sukhumvit 41 – 71 Wireless Road

Si Phraya, Suriwong and Silom Road Sukhumvit 50 – Bangna intersection Sukhumvit 77 – 103 Thiem Ruammitr Road Yen-a-kart

Sampawut intersection – Samlong expressway (Sukhumvit 105 – Samlong) Samsaen Road Sathupradit Road Somdej – Chaopraya Road Srinakarin – Teparak Thapra Vorajuk

Zone 5

Bangna Trad km. 11 – 20 Chaengwattana Road Donmuang Airport Kingkrew – Lumlooka Minburi - Romklao

M. Thana City Nonthaburi Pakkret – Rangsit Pranangklao Road Ramindra - Watcharapol

Ratanatibej Road Samakee Road Saimai Road Sapanmai Sukhapibal 5

Suwinthawonge – Nongjok Theparak – Electricity intersection Tiwanon Road

Bang Bua Thong Bangkae Bangna Trad km. 21 – 30

Boromratchachonnanee Road Kanchanapisek Road Petchakasem Road

Puttamonthon Road Rama 2 Suksawad Road

Talingchon

Zone 6

• •

Zone 6 is for any further areas. However, Montri will not provide transportation for any areas more than 35 kilometers from the school. For other areas not mentioned above, or for assistance in identifying your zone, please contact Montri’s customer service line at 02 906 0160 ext. 301-304

Release of Liability for Bus Riders with Severe Allergies I acknowledge that by signing page 1 of this document, I am agreeing to release NIST International School (“NIST”) and Montri Transport Corporation Public Company Limited (“Montri”) from liability for any issues related to severe allergies. I have therefore been advised to read this document carefully before signing it. By signing this document I, the undersigned, as the parent/guardian of the participant named below, understand and agree as follows: 1.

2. 3. 4. 5. 6.

NIST is committed to providing every child enrolled in the school with a quality, caring education. This includes taking reasonable precautions to ensure the safety and security of those with allergies. These precautions include, but are not limited to, the dissemination of relevant medical information to staff, the training of NIST and Montri staff in recognizing the signs of allergic reactions, and the effort to ensure that children with allergies are not exposed to allergens. Montri staff members are not equipped or legally capable of providing emergency care, including the administration of epinephrine injections in any form, to children who may suffer allergic reactions. On the NIST campus, NIST nurses may administer epinephrine injections through epipens if parental consent has been given in writing. I understand that it is my responsibility to provide my child with the proper knowledge and training to avoid the possibility of exposure to allergens and to enable him/her to self-administer medication in the event of an allergic reaction. I will submit a signed document from a licensed physician indicating that my child does not face significant risk resulting from allergic reactions by being in enclosed areas, including in vehicles, with other children and adults. I hereby release NIST and Montri, including their directors, employees and representatives, from any and all claims and/or liability arising from incidents related to allergic reactions that my child might have while in transit on Montri-owned and operated vehicles. This document shall be governed by and construed in accordance with Thai law.

I affirm that I am the legal parent/guardian of the participant, who is under 20 years of age. I have read the above release and am fully familiar with the contents thereof. In consideration of enrolling my child in NIST, I hereby consent to the foregoing on behalf of my child and agree that this release shall be binding upon my child and me.

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Updated 2018 March 20