Guilford Public Schools Request for Transportation To/From ...

Guilford Public Schools Request for Transportation To/From

Secondary Address

Please complete this form if you would like your child/children to be picked up or dropped off at a location other than your home address. If you have more than one child, please complete a separate form for each request. If you do not know the bus or stop information just leave the space blank and it will be completed by our staff.

Return the completed form to Chip Dorwin, Transportation Coordinator, at dorwinc@. When the request is approved the form will be scanned to you, the bus company and the school. We will try and accommodate all requests on space and route availability.

Please note that requests are for one school year only.

Please print legibly Student Name___________________________________ Grade ______ School _______________ Primary Address __________________________________________________________________ Assigned Bus _______ Assigned Bus Stop ______________________________________________ Days at this stop ? note am/pm or both if known ________________________________________ Adult at this stop for kindergarten students' ____________________________________________ Relationship to the kindergarten student _________________Phone ________________________

Secondary Address ________________________________________________________________ Requested Bus If known ________ Requested Bus Stop if known ___________________________ Approximate Pickup/Drop-off Time ________ AM ________ PM (to be completed by coordinator) Days at this stop ? note am/pm or both if known ________________________________________ Adult at this stop for kindergarten students' ____________________________________________ Relationship to the kindergarten student _________________ Phone _______________________

Notes if any:

Parent/Guardian submitting this form _________________________________________________ Relationship to the student _________________________________________________________ Phone ___________________________ Email __________________________________________

----------------------------------------------------------------------------------------------------------------------------------For Office Use Only

Request approved ______________ Date to implement approved request ________________________ Transportation Coordinator _____________________ Date _______________________________

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