Medina Central School District Transportation Request
This information is critical for planning purposes. This form MUST be completed for EACH student by a parent/guardian.

*** Transportation Requests Can Take Up to 30 Days to Take Effect as per School Policy #5721 ***
Student's First Name *
Student's Last Name *
Student's gender *
Required
Birth Date *
MM
/
DD
/
YYYY
Building and Grade Level *
Student's Home Address *
Babysitter/Day Care Address
Parent/Guardian Full Name *
Parent/Guardian's Phone Number *
Parent/Guardian E-mail
How will your child get TO SCHOOL? (Where will transportation pick them up?) *
Home
Babysitter/Day Care
No transportation needed
Monday
Tuesday
Wednesday
Thursday
Friday
How will your child LEAVE school? (How will they get home?) *
Bus to Home
Bus to Day Care/Babysitter
Walker - must live in walk zone
Pick Up - per building procedures
No transportation needed
Monday
Tuesday
Wednesday
Thursday
Friday
By typing my name below, I certify that I am the parent/guardian of this student and authorize transportation as indicated above. *
Submit
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