16-17 Keystone Central School District Transportation Form
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116-17 Keystone Central School District Transportation Form
Will your child ride:
(Only Complete for Transportation Changes)
Primary Busing
School Attending
____ Ride the bus AM & PM
____ Ride the bus AM Only
Student Name:
___________________________________________________
____ Ride the Bus PM Only
(Last,
First,
MI)
____ Walk to school
Township/Boro:
_____________________________
Grade:
_ ___
____ Parent transport
____ Student Driver
911 Address :________________________________________________ ________
If your child is a walker, parent
City:_______________ _________________ State:____ Zip:_________________
transport or student driver
please only fill out the top
Effective Date For Busing to begin: _______________________________________
section
REMINDER: WALKERS ARE NOT ELIGIBLE FOR BUSING
ONLY FILL OUT THIS SECTION IF YOU THINK
CHANGE OF ADDRESS
YOUR CHILD IS ELIGIBLE FOR BUSING.
Parent or Guardian with whom the child resides
EFFECTIVE DATE:
Guardian Name:_________________________________
NEW 911 ADDRESS:
Relationship to student: ___________________________
Phone Number:______________ Cell: ______________
Emergency Care Information
Name: _________________________________________
Phone Number:______________ Cell:_______________
NEW MAILING ADDRESS:
Same as 911 address
Relationship to Student:___________________________
Name: _________________________________________
Phone Number:_____________ Cell: ________________
Relationship to Student:___________________________
ONLY FILL OUT THIS SECTION IF YOUR CHILD IS ELIGIBLE
FOR BUSING AND YOU ARE REQUESTING ADDITIONAL
BUSING SUCH AS SECOND HOUSEHOLD OR DAYCARE.
Second Household Name:__________________________
USE ONLY
TRANSPORTATION OFFICE
(Parent or Guardian)
911 Address: ____________________________________
EFFECTIVE DATE OF BUSING CHANGE
City:____________________State:____Zip:___________
Phone Number:_______________ Cell:______________
Daycare Name: _________________________ _________
AM ROUTE #:
(Babysitter, Grandparents, etc)
PICK UP TIME:
911 Address: ____________________________ ________
DESCRIPTION:
City: __________________State:____Zip:_____________
Phone Number: _______________ Cell:______________
Circle Specific Days:
When riding to Second Household or Babysitters
PM ROUTE #:
Monday
Tuesday
Wednesday
Thursday
Friday
DROP OFF TIME:
DESCRIPTION:
Circle Specific Times:
When riding to Second Household or Babysitters
Before & After School
Before School Only After School Only
TRANSPORTATION DEPARTMENT WILL APPROVE BUSING IF: THERE IS AN ESTABLISHED BUS ROUTE,
THERE IS ROOM ON THE BUS AND THE STUDENT IS ELIGIBLE FOR TRANSPORTATION FROM PRIMARY
RESIDENCE. REMINDER: WALKERS ARE NOT ELIGIBLE FOR BUSING.
ROUTE INFORMATION CAN BE FOUND AT:
– Administration – Transportation – School Bus Route Information
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