Application for Continuing Transportation
DO NOT USE IF REQUESTING TRANSPORTATION FOR THE FIRST TIME! Use only for CONTINUING private and parochial school transportation. For information regarding kindergarten or first time requests, please call Central Registration at (631)471-7861 or visit the Sachem Transportation Office of Central Registration Webpage.
Email address *
****ONE FORM PER STUDENT****
Student's First Name *
Your answer
Student's Middle Name *
Your answer
Student's Last Name *
Your answer
Home Address *
Your answer
Alternate Pick up or Drop Off Address (if applicable) *
Your answer
School the student will be attending in September 2019 *
Your answer
Grade the student is entering in September 2019 *
Student Date of Birth *
MM
/
DD
/
YYYY
Parent or Guardian Name: (First Name & Last Name) *
Your answer
Home Telephone Number (including area code) *
Your answer
Emergency Telephone Number (including area code) *
Your answer
Work Telephone Number (including area code) *
Your answer
****TRANSPORTATION INFORMATION****
In accordance with the laws of New York State, I hereby formally request transportation for my child to:
Name of School *
Address of School *
Your answer
School Telephone Number (including area code) *
Your answer
School Hours for September 2019 *
Your answer
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree that the information I have provided is accurate and truthful. *
Required
If you have any questions in regards to this form, please direct all contact to:
Joseph Cervone, Transportation Supervisor. jcervone@sachem.edu Transportation Office 51 School Street Lake Ronkonkoma, NY 11779 (631) 471-1380
A copy of your responses will be emailed to the address you provided.
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