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Transportation Emergency Card
Student First Name (Legal Name)
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Student Last Name (Legal Name)
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School
Student Birth Date
MM
/
DD
/
YYYY
Student Home Address
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Student Medical Concerns
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Student Medication
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Primary Parent/Guardian Name
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Primary Parent Home Phone
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Primary Parent Cell Phone
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Primary Parent Work Phone
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Alternate Parent Name
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Alternate Parent Home Address
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Alternate Parent Phone
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Alternate Parent Work Phone
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Emergency Contact Person Name
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Emergency Contact Person Phone Number
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Student AM bus number
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If this student transfers buses in the AM, what is the second bus number?
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Student PM bus number
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If this student transfers buses in the PM, what is the second bus number?
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If the student has special bus daily pick up or drop off needs, please describe them below:
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