Childcare Request Form
The Rocky River Board of Education realizes that it may be necessary to provide an alternate transportation location for students that require childcare providers. The service must be practical, cost effective and meet the needs of both the parent and the school district.

Based on Board policy, transportation to and from a childcare provider will be based on the following criteria:

1. For service to start, please complete Childcare Request Form as soon as possible. The Transportation Department is committed to being flexible and available for any changes a parent may need. Forms may take 2 business days to go into effect, however, we will process your request as quickly as possible.

2. The service must be for five (5) days per week. Service is for the entire school year or until permanently changed in writing. This will reduce the possibility of your child being taken to the wrong destination.

3. The location of the childcare provider to or from which the student is to be transported must be located in an area designated by the Board as eligible for bus transportation to the school of attendance.

4. All students must have a Childcare Request Form on file in order for transportation service to begin.

Childcare Request Forms are effective for the current school year only and must be completed on a yearly basis.

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Student's Name (Last, First) *
Student's School *
Student Grade *
Childcare Provider *
Daycare center or private residence must be within district boundary.
Required
Private Residence Information
If choosing a private residence, you must provide: Providers name, address and phone number.
Pick up drop off at Childcare Provider *
AM Bus pick-up, PM drop off or both AM/PM
Parent First Name *
Parent Last Name *
Home Address *
Apartment Number
City *
Parent Contact Number *
Home or cell
2nd Parent Contact Number
Home or Cell
Parent e-mail *
Emergency Contact Name *
Emergency Contact Phone Number *
Signature and acknowledgement
I am requesting that my child (listed above) be transported from and/or to locations other than school and my residence. I understand that the alternate locations will be permanent address for pick up and drop off and be located on a regularly established bus route at the time of day that I am requesting service.

I hereby release the Rocky River School District, its Board of Education, its officers and employees from any liability which may result from complying with my request for transportation of my child from and/or to a location other than school and my residence.

I acknowledge that once my child is transported from/to the designated pick up and/or drop off point, I assume full responsibility for the safety and welfare of my child. I will be certain that my child knows the destination each day and also knows the backup plan at each location in the event that my child finds no one available at the destination.

It is suggested that the childcare provider meet your child at the bus stop. All students are to be at their assigned bus stop 5 minutes prior to the scheduled pick up time.
Your name indicates you have read and acknowledge the above statements and information. *
Comments or additional information
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