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Series 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

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OFFICE USE:  School rec’d____________ Copy to Transportation _____________ Transportation rec’d _______________

Procedures/707.5.2P/9-4-14