Day Care Provider Forms White Bear Lake Area Schools

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White Bear Lake Area Schools - Transportation Department
4855 Bloom Avenue, White Bear Lake, Minnesota 55110 (651) 407-7538
Please complete this form for each of your children that attend a day care facility.
Parent/Guardian Name
Date
Address/City
Zip
Home Phone Number
Work/Cell Phone Number
I prefer to be contacted by:
Home Phone
Work/Cell Phone
Student Name
Grade
Assigned School
Requested School
Child Care Provider's Name
Address
Provider's Phone Number
Effective Date
School boundaries have been established for each school in the White Bear Lake Area. Students are
assigned to a school based on the established boundaries. Transportation services will be provided for
students who attend a daycare facility under the follow guidlines:
1. Students will be transported from a daycare facility to a White Bear Lake Area school within the daycare's
established boundary.
2. Students must always be picked up or dropped off at the same location.
Student is to be picked up at:
Home
Day Care
Student is to be dropped off at:
Home
Day Care
Mail to: White Bear Lake Area Schools
Email:
Transportation Department
(please include all information above in your email)
4855 Bloom Avenue
Print Form
White Bear Lake, MN 55110
Fill out form first, and use
Fax to: (651) 653-2756
this button to print.
For Office Use Only
_____Approved
_____Denied
Notified by: ____________ Date: ____________ Time: ____________

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