UPPER SANDUSKY SCHOOLS

TRANSPORTATION DEPARTMENT

This form is for use when you are requesting an alternative stop location for your child.

As a safety consideration for your child it is important that the Transportation Department have current information.  Medical and designated place of safety forms must be on file.

This form must be filled out every school year and returned to the Bus Garage 72 hours in advance.

I AM REQUESTING THAT THE FOLLOWING STUDENT BE TRANSPORTED TO/FROM AN ALTERNATIVE ADDRESS:

STUDENT NAME _________________________________ SCHOOL____________

HOME ADDRESS________________________________________ GRADE_______

ALTERNATIVE RESIDENCE NAME______________________________________

ALTERNATIVE ADDRESS ______________________________________________

ALTERNATIVE PHONE_________________EMERGENCY PHONE____________

DAYS OF WEEK:  MON_____ TUES_____WED_____THURS_____FRID_____

            AM_____    PM_____    BOTH_____

DATES TRANSPORTATION REQUESTED:  FROM____________ TO___________

PARENT/GUARDIAN SIGNATURE________________________________________

THIS REQUEST WILL BE APPROVED IF THE ALTERNATIVE STOP IS ON A BUS RUN AND THE STOP WILL BE CONSISTENT AND SPACE IS AVAILABLE.

THIS SECTION FOR COMPLETION BY THE TRANSPORTATION DEPARTMENT

REGULAR BUS NUMBER ASSIGNED        AM _____    PM _____

ALTERNATIVE BUS NUMBER ASSIGNED    AM _____    PM _____

APPROVED BY: __________________________________   DATE _______________