Transportation Contract Fprm-School District Of Black River Falls printable pdf download

Transportation Contract Fprm-School District Of Black River Falls

School District of Black River Falls Transportation Department

2016-2017 Student Transportation Contract

Please use a separate form for each child

Name:

Grade:

School:

_________________________________

Home Address:

_________________________________

(_____) ______ - ___________

Home Phone:

Parent/Guardian Information:

_____________________________

(____) ______ - ____________

Name

Phone Number

_____________________________

(____) ______ - ____________

Name

Phone Number

Please select up to two (2) pick up and drop off locations for your child. This schedule must be a

set schedule each week. Any deviation to this schedule becomes the parents’ responsibility to

transport in accordance with School Board Policy 751. Contract must be completed before your child

will be transported. It may take up to three (3) school days to process contract changes. You will

be notified when changes have been processed.

AM Pick Up Location

PM Drop Off Location

Mon

Tues

Wed

Thurs

Fri

□

My child does not need morning

My child does not need afternoon bus

bus transportation at this time

transportation at this time

By completing the Student Transportation Contract, both the parent and the student are agreeing

to the rules and policies stated within the Transportation Handbook.

____________________________

____/____/____

Parent Signature

Date

**Transportation Department Use Only**

Date Received ______ / ______ / ______

Date Processed ______ / ______ / ______

AM Bus #

________

School Notified ______ / ______ / _______

Noon Bus #

________

Parent Notified ______ / ______ / _______

PM Bus #

________

□ 4K/EC AM □ 4K/EC PM □ Special Needs

□ Wheelchair

□ Car Seat

Transportation Contract Fprm-School District Of Black River Falls

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