MID COLUMBIA BUS COMPANY
REQUEST FOR TRANSPORTATION SERVICES-NEED SEPARATE FORM FOR EACH STUDENT EVERY YEAR
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For which school year are you registering? *
School *
AM Route # (if known)
PM Route # (if known)
Student Name *
Grade *
Street Address *
Address and City
Mailing Address *
Contact Phone Number *
Secondary Phone Number
Route Times *
Reason for Request *
Request New Stop (give address)
Check which days student will ride *
Required
Parent/Guardian's Name *
Parent/Guardian's Email *
Release Information - Kindergarten Only
Student can be released to the following
Person #1
Name #1
Phone #1
Person #2
Name #2
Phone # 2
Person #3
Name #3
Phone #3
Person #4
Name #4
Phone # 4
Kindergarten students will NOT be dropped off without an authorized adult present.
FOR MORE INFORMATION  CONTACT:  Sherrell Sears, Location Manager
Phone:  503-767-2480        Fax:  503-767-2482
Email:  sherrell.sears@midcobus.com
School Website:  www.nssd29j.org/departments/transportation
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