School Bus Stop Assignment and Change Form

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Education Code 49558 makes all information provided confidential and unavailable for any other purpose.

Email *

Parents/Guardians:

The purpose of the School Bus Stop Assignment and Change Form is to serve as an official communication between the
parent/guardian and the bus driver in an effort to successfully and safely transport your child to their correct bus stop.
Please note the following:

- Students will be allowed to ride the bus only if they have a School Bus Stop Assignment and Change Form on file.

- If you want your child to get off at a bus stop other than the stops you designate below, you must send a note to the
school office giving your approval for the change. It will be signed by office staff and then given to the bus driver
when your child boards the bus.

- Exception: High school students may ride any bus after school when they provide the driver with a note that has their
name and the departing bus stop. Blank note forms are available in the high school office.

Student's First Name *

Student's Last Name *

Student's LUSD email address (if known) *

Important:

When reviewing the bus schedule to determine the correct bus stop, look for the symbols ** next to the bus stop, these symbols indicate the only stops where students will be escorted across the roadway. All other stops are right hand deliveries only and no crossings will be allowed. If you have any questions regarding bus stops, call the Transportation Department at (707) 262-3022.

Morning Bus Route: Please refer to our website for temporary bus schedules *

AM Route 3

AM Route 4

AM Route 5

Required

Please enter AM pick up location from our temporary bus schedules on our website *

Afternoon Bus Route: Please refer to our website for temporary bus schedules *

PM Route 3

PM Route 4

PM Route 5

Please enter PM pick up location from our temporary bus schedules on our website *

Please select one of the following: *

I authorize the LUSD Transportation Department to release my kinderarten child at the bus stop

My kindergarten child is not to disembark the school bus unless a caretaker is present

I authorize the LUSD Transportation Department to release my student at the bus stop

Required

Parent's Full Name *

Parent's Primary Phone Number *

By selecting this box, you agree that all information is correct to the best of your knowledge. *

I Agree

Required

Send me a copy of my responses.

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