Bus Permission Form

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Bus Permission Form

Please fill out this form if your student will ride the bus at anytime throughout the year.

The following behaviors will not be tolerated on the school bus:

Fighting
Bullying/Harassment
Throwing materials on the bus
Destruction of property
Possession or use of alcohol and/or illegal drugs
Possession of knives, weapons or other items deemed dangerous by the Administration
Use of tobacco/tobacco products/tobacco substitutes
Defying and disobeying the bus driver
Use of foul language
Creating any other disturbance deemed dangerous by administration and bus driver

Student Name *

Morning Pick-Up Location (Please List an address) *

PM Drop Off Location (Please List an address or write N/A if you will be picking your student up at school) *

My student is in 4th or 5th Grade and is allowed to be picked-up and dropped off at the bus stop without any parental supervision. *

Yes

I have a student in 4th or 5th grade and another in k-3rd grade. If my 4th/5th graders is with my K-3rd grader, both students are allowed to be picked up and dropped off at the bus stop without parental supervision. *

Yes

The Following adults are allowed to receive my students at the bus stop. (You must include their full name and phone number)

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