School Bus Program Online Application
Busing Requests fulfilled on a first-come basis.
School and Logistics Information
*  Name of School
*  Teacher's Name
*  Telephone Number
*  Email Address
*  Subject and/or Grade
*  Number of Students
*  Total number of passengers (include teachers, students and chaperones)
Have you had Coexistence or Embracing Our Differences training?
YES
NO
     
Budget 1 hour to view Art Exhibit (in addition to travel time)
Do you wish to add 1/2 hour for bag lunch option and restrooms?
YES
NO
     
1st Choice - Date:
 
Departure Time:
 
Must be back by:
 
 
 
2nd Choice - Date:
 
Departure Time:
 
Must be back by:
 
 
 
3rd Choice - Date:
 
Departure Time:
 
Must be back by:
   
       
 
Your School Hours: Students arrive at:
  Students dismissed at:
If you need more than on bus... can the students be shuttled so that one bus can return for another group of students?
YES
NO
     
Does this field trip involve a film showing with the Sarasota Film Festival?
YES
NO
     

Please direct any questions related to this field trip and scheduling of buses to:

Joni Steinberg, Ph. D.
(o) 346-2386 (c) 724-0862
(Fax) 346-2440 ( a cover sheet is not required)
email: jssteinberg@aol.com
 
Thank you for helping provide a meaningful experience for our children
 

 

 

0){echo '

 

' .'

There were problems with your contact submission' .'

Your name, phone or email must be filled out!' .'

Please use the back button to return to the contact form' .'

'; }else{ //// STRIP ALL QUESTIONABLE CHARACTERS function striptease($virgin){ $remove = array('Content-Type:','\n','\r','\\', '/', '\'', '?', '!', '|', '^', '~', '@', '&', '%', '$', '"', '+', '*', '=', '>', '<', '(', ')', '{', '}', '[', ']', ':', ';', '#', '`', ','); $virgin = str_replace($remove,'',$virgin); $virgin = htmlspecialchars($virgin); return "$virgin"; } //// STRIP ALL QUESTIONABLE CHARACTERS FOR EMAIL function stripteaseme($virgin){ $remove = array('Content-Type:','\n','\r','\\', '\'', '?', '!', '|', '^', '~', '&', '%', '$', '"', '+', '*', '=', '>', '<', '(', ')', '{', '}', '[', ']', ':', ';', '#', '`', ','); //$remove = array('Content-Type:','\n','\r','\\', '/', '\'', '?', '!', '|', '^', '~', '&', '%', '$', '"', '+', '*', '=', // '>', '<', '(', ')', '{', '}', '[', ']', ':', ';', '#', '`', ','); $virgin = str_replace($remove,'',$virgin); $virgin = htmlspecialchars($virgin); return "$virgin"; } $place = striptease($_POST['school']); $person = striptease($_POST['teacher']); $wire = striptease($_POST["phone"]); $electronic = stripteaseme($_POST["email"]); $subject = striptease($_POST["topic"]); $snumber = striptease($_POST["students"]); $pnumber = striptease($_POST["passengers"]); $prepared = striptease($_POST["training"]); $food = striptease($_POST["lunch"]); //$date1 = preg_replace('/', '-', $_POST["date1"]); //$d1 = striptease($date1); $d1 = striptease($_POST["date1"]); $dp1 = striptease($_POST["depart1"]); $r1 = striptease($_POST["return1"]); $d2 = striptease($_POST["date2"]); $dp2 = striptease($_POST["depart2"]); $r2 = striptease($_POST["return2"]); $d3 = striptease($_POST["date3"]); $dp3 = striptease($_POST["depart3"]); $r3 = striptease($_POST["return3"]); $arrive = striptease($_POST["arrival"]); $depart = striptease($_POST["dismissal"]); $shuttled = striptease($_POST["shuttle"]); $SFFfilm = striptease($_POST["film"]); //$to = 'barbara@diederich.com'; $to = 'jssteinberg@aol.com'; $ccme = 'MichaelJShelton@comcast.net'; $subject='School Bus Program'; $headers = "From: $electronic\r\n"; $headers .= "cc:$ccme \r\n"; $headers .= 'MIME-Version: 1.0' . "\r\n"; $headers .= 'Content-type: text/html; charset=iso-8859-1' . "\r\n"; $message = "A new bus program request was sent by $electronic as follows: \r\n" ."

Name: $person\r\n" ."
School: $place \r\n" ."
Phone: $wire \r\n" ."
Email: $electronic \r\n" ."
\r\n" ."
============================================== \r\n" ."
\r\n" ."
Number of Students: $snumber \r\n" ."
Number of Passengers: $pnumber \r\n" ."
Has received EOD training: $prepared \r\n" ."
Want time for lunch and restrooms: $food \r\n" ."
\r\n" ."
============================================== \r\n" ."
\r\n" ."
1st Request: For $d1 to depart at $dp1 and return at $r1 \r\n" ."
\r\n" ."
2nd Request: For $d2 to depart at $dp2 and return at $r2 \r\n" ."
\r\n" ."
3rd Request: For $d3 to depart at $dp3 and return at $r3 \r\n" ."
\r\n" ."
============================================== \r\n" ."
\r\n" ."
Students arrive at $arrive and depart at $depart \r\n" ."
\r\n" ."
Can the students be shuttled: $shuttled \r\n" ."
\r\n" ."
Are the students going to watch a SFF film: $SFFfilm \r\n" ." \r\n" ." \r\n"; mail($to, $subject, $message, $headers); echo '

 

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Thank you very much

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Your Bus Program Request has been submitted!

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