ABRSD Elementary One Day Pass Request for Students in Grades 2-6
This form must be completed and submitted before 2:00 pm the day before for which the change is effective, otherwise the student will be dismissed according to his/her usual dismissal procedure. For example, if the bus pass is for Tuesday, September 12, this form must be submitted by 2:00 pm on Monday, September 11.
Bus changes cannot be taken over the phone, except ONLY in an emergency CALL Transportation 978-264-3328
You will need the bus number and existing bus stop (name of place is not a) for the pass.
If you are unsure of the bus number needed for this pass, please look up the address here:
http://www.infofinderi.com/tfi/address.aspx?cid=ARS5OMB7LJU3
and return to this form.
* Required
Today's Date
MM
/
DD
/
YYYY
Student Name
*
Your answer
Teacher Name - Room Number:
*
Choose
Mrs. Kokkinos - Room 7
Mrs. Luongo - Room 10
Mrs. Olson - Room 8
Ms. Johnson - Room 18
Mrs. Hussey - Room 20
Mrs. May - Room 9
Mrs. Walsh - Room 19
Mrs. Cormier - Room 17
Ms. Melbourne - Room 11
Mr. Wolfson - Room 15
Mrs. Acheson - Room 14
Mrs. Conley - Room 13
Mrs. Montepeluso - Room 12
Day of Week for Bus Pass:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Date of Bus Pass:
*
MM
/
DD
/
YYYY
Student will Ride on Bus Number:
*
Your answer
To Existing Bus Stop Location:
*
Existing Bus Stop Only - Names of Places not Accepted
Your answer
Receiving Adult Name:
*
The student will be in the care of this person.
Your answer
Receiving Adult Phone Number:
*
Phone number of person student will be in the care of.
Your answer
Name of Parent/Guardian Requesting Bus Pass:
*
Your answer
Phone number of Parent/Guardian Requesting Bus Pass:
*
Your answer
Student's regular bus # is
*
Your answer
Regular Bus Stop Location
*
Your answer
You must select "yes" to electronically sign this request
*
Yes
Submit
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