2016-17 School Bus Transportation

One form per family

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* 1. PARENT/GUARDIAN

First Name: *

Last Name: *

Address:

City/Town:

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* 2. NOT USING SCHOOL BUS

Our children will NOT be riding the bus.

If any of your children will be riding the bus at least once during the school year, please complete the additional questions.

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* 3. One Way Mileage From Your House to School

0-2 MILES

OVER 2 UP TO 5 MILES

OVER 5 UP TO 8 MILES

OVER 8 UP TO 12 MILES

OVER 12 MILES

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* 4. CHILD'S NAME

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* 5. How often will this child ride the school bus during the school year

1-90 Days

Over 90 Days

Will Not Ride the Bus

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* 6. CHILD'S NAME

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* 7. How often will this child ride the school bus during the school year

1-90 Days

Over 90 Days

Will Not Ride the Bus

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* 8. CHILD'S NAME

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* 9. How often will this child ride the school bus during the school year

1-90 Days

Over 90 Days

Will Not Ride the Bus

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* 10. CHILD'S NAME

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* 11. How often will this child ride the school bus during the school year

1-90 Days

Over 90 Days

Will Not Ride the Bus