Portal

ESY Transportation Information

(To be completed by the student’s parent/guardian)

Student ID:

Student Name - First*

Last*

The following questions will aid us to determine the transportation needs of your child.

I will provide transportation for my child to AND from the LCSD ESY Program.

Yes No

My child will need transportation to AND from the LCSD Program.

Yes No

My child should be picked up AND dropped off at home.

Yes No

My child should be picked up and/or dropped off at his/her child care provider?

Yes No

Child Care Provider’s Name:

Child Care Provider’s Address

Child Care Provider’s Phone/Cell:

Transportation From/To Child Care Provider:

AM Only PM Only Both AM & PM

Yes No

My child will attend the BASCOL program during the summer.

Mon. AM Only PM Only AM & PM

My child will attend BASCOL on:

Tues. AM Only PM Only AM & PM

Thur. AM Only PM Only AM & PM

Wed. AM Only PM Only AM & PM

Fri. AM Only PM Only AM & PM

My child will attend Casey’s Place on the following day(s):

For office use:

***************************************************************

AM Bus Route#

PM Bus Route#

DOB*

Please add additional comments or concerns that you want the Special Education or Transportation Department to be aware of.