Mason City Community Schools District Bus Application

PLEASE COMPLETE ONE APPLICATION PER FAMILY
Please indicate the school year for which transportation is requested.
Name of Parent/Guardian
Your answer
Applied for Fee Waiver?
Home Street Address
(No PO Box - Need Street Address)
Your answer
Home Phone
Your answer
Payment Term
First Student's Full Name
Your answer
First Student's Gender
First Student's School Attending
First Student's Grade Level
First Student's Pick Up
Please check if riding AM, PM, or both
Required
Second Student's Full Name
Your answer
Second Student's Gender
Second Student's School Attending
Second Student's Grade Level
Second Student's Pick Up
Please check if riding AM, PM, or both
Third Student's Full Name
Your answer
Third Student's Gender
Third Student's School Attending
Third Student's Grade Level
Third Student's Pick Up
Please check if riding AM, PM, or both
Fourth Student's Full Name
Your answer
Fourth Student's Gender
Fourth Student's School Attending
Fourth Student's Grade Level
Fourth Student's Pick Up
Please check if riding AM, PM, or both
Fifth Student's Full Name
Your answer
Fifth Student's Gender
Fifth Student's School Attending
Fifth Student's Grade Level
Fifth Student's Pick Up
Please check if riding AM, PM, or both
Sixth Student's Full Name
Your answer
Sixth Student's Gender
Sixth Student's School Attending
Sixth Student's Grade Level
Sixth Student's Pick Up
Please check if riding AM, PM, or both
*****Please complete below if daycare, pick up or drop off is different than home address.*****
Name of Daycare or Other Provider
Your answer
Relationship
Your answer
Phone
Your answer
AM Address For Pickup
Your answer
PM Address For Drop Off
Your answer
Please enter your email address (optional)
Your answer
Please enter additional comments (optional)
Your answer
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