Adopted: July 1979
Revised: September 2014
Download 707.5.2P - Transportation for Students in Daycare or to an Alternate Address
PARENT/GUARDIAN: This form must be completed for any move to daycare or change of daycare location by a resident or non-resident elementary school student within the attendance area of the school the student currently attends. (Non-resident elementary school students must already have approved Procedure 502.4.4P, Student Transfers: Daycare for Students in Grades K-5, on file in the district for the school year in question.) This form may also be used for students in grades 6-8 if requesting an alternate address within attendance area of the school boundaries.
Student
last name first name middle initial grade
Home address
# and street name city zip code
Parent(s) or Guardians(s)
last name first name middle initial
home phone work phone cell phone
Daycare provider
last name first name daycare phone
Daycare provider address
# and street name city zip code
School attending School year
Transportation Information: Start Date:
Daycare or Alternate Address: No Transportation: (circle) daycare transports, SACC, walker
To School: ____M____T____W____TH____F To School: ____M____T____W____TH____F
From School:____M____T____W____TH____F From School: ____M____T____W____TH____F
Home:
To School: ____M____T____W____TH____F
From School: ____M____T____W____TH____F
I understand it is my responsibility to transport my child from home to daycare or an alternate address and from daycare or an alternate address to home, and that it is the school district’s responsibility to transport my child to and from the designated bus stop for the daycare or alternate address.
School/transportation must be notified of any change in this information during the current school year. This information will remain active for the entire time the student attends the school listed above or until the information is changed by the parent.
Parent/Guardian signature date
RETURN TO: Student’s elementary school/middle school