Security Blanket Form*

Name:  __________________________________________________________________

Address:  ____________________________________________

City: __________________________ State:________ Zip____________ 

Daytime phone:  (_____) _________________________

Date of occurrence:__________________ Train #________________

Stations (origination/destination):______________________________________________ 

Childcare provider:  ________________________________________________________

Address:  ________________________________________________________________

City: __________________________ State:________ Zip____________ 

Phone number:  (_____) _________________________

**State license #:  ____________________________________________

Fee charged (receipt attached): _________________________

*Virginia Railway Express riders will be indemnified against childcare late charges up to 4 times per year as a result of any train being fifteen (15) minutes or more late to the passenger's destination station (Amtrak trains excluded). Daycare must be located within 30 minutes of the VRE station

**Childcare provider must be state or county licensed to be eligible for reimbursement.

VRE rider must return the completed form below to VRE within five (5) business days of the late train. Reimbursement will occur within thirty (30) days of receipt of form, receipt and VRE ticket. For more information, call (703)684-1001.

For reimbursement, please return form with a copy of the ticket and the daycare receipt to:

Virginia Railway Express
Att: VRE Security Blanket
1500 King Street, Suite 202
Alexandria, VA 22314-2730