South Colonie Transportation Department
Non-Public School Annual Transportation Request
Please fill in information below
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DD
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YYYY
School Name
Your answer
Student's Last Name
Your answer
Student's First Name
Your answer
Home Address (house/apt#, Street, City,State,Zip
Your answer
Home Phone# (in format 999-999-9999)
Your answer
Student's Grade Level
Student's Date of Birth
MM
/
DD
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YYYY
Student's Gender
Contact Information
Parent#1 Last Name
Your answer
Parent#1 First Name
Your answer
Parent#1 Relationship to Student
Parent#1 - Legal Guardian?
Parent#1 Contact Phone# (in format 999-999-9999)
Your answer
Type of Phone# (parent#1)
Parent#2 Last Name
Your answer
Parent#2 First Name
Your answer
Parent#2 Relationship to Student
Parent#2 - Legal Guardian?
Parent#2 Contact Phone# (in format 999-999-9999)
Your answer
Type of Phone# (parent#2)
Transportation Request for:
Required
Pickup/Dropoff at APPROVED child care locations
Students may be picked up or dropped off at APPROVED child care locations if the request is submitted by April 1st. However, pick-up and/or drop-off must occur at the SAME ADDRESS for ALL five days of the week and be WITHIN district boundaries.
AM Pick-up Address
Your answer
PM Drop-off Address
Your answer
Daycare Provider
Your answer
Daycare Provider Phone# (in format 999-999-9999)
Your answer
Authorization Area
Your Name
Your answer
Authorization
Required
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