TRANSPORTATION CHANGE

(Or)  Child Care Provider Change

Requests should be submitted at least a week in advance to be approved by the Transportation Dept.

Please turn form in to the school office.

Does your child ride the bus currently? ___________________________

WHAT IS THE CHANGE IN TRANSPORTATION? __________________________________________________________________________

 __________________________________________________________________________ 

Monday_________Tuesday________Wednesday_________Thursday______________Friday______________

__________________________________________________________________________

Start date of transportation change?  _________________________

Child Care Provider: _____________________Phone #______________Cell #_______________

Address: _____________________________________________________________________

Description of location (Example:  second farm on the right on Valley Road or next farm past John Smith’s):

(If different than the above schedule, a bus pass needs to be obtained by sending a note or calling the secretary of the building that the child attends.)

Student / Students: ____________________________________________________________

Parents/Guardian: ______________________________________________________________

Parent/Guardian Signature: ____________________________________Date: ____________

Home Address:________________________________________________________________

Phone #: _________________Work #_________________Cell Phone #:_________________

                                                       (office use)

Request approved: _________________________Request denied: _______________________

Bus Number student will ride to/from Child Care Provider: ______________________________

Transportation Dispatch Signature: _____________________________Date:______________