Bus Transportation Form Please Cirlce: Kind Y5’s

Kindergarten/Young 5’s

Student’s Name __________________________________________________

Last First MI

Address________________________________________Phone__________

Parent/Guardian Name(s)________________________________________

Special Medical Conditions/Problems/Concerns:_____________________

_____________________________________________________________

_____________________________________________________________

Student will be PICKED UP at:

_____________________________________________________________

(Street Address)

_____________________________________________________________

(Person’s Name) (Phone)

Will the student be picked up every day at this address?_____ If not, what days? M T W Th F

Student will be DROPPED OFF at:

_____________________________________________________________

(Street Address)

_____________________________________________________________

(Person’s Name) (Phone)

Will the student be dropped off every day at this address?_____ If not, what days? M T W Th F

If the information above changes, contact your student’s school office to complete a new form. Occasional variations from student’s transportation schedule may be made by calling the school office or by sending a note to the student’s teacher.

For Office use only: