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JORDAN-ELBRIDGE CENTRAL SCHOOL DISTRICT

Transportation Department

PO Box 902
Jordan, NY 13080

315-689-8500 X5601

Directions: Please provide the information requested.
Note: This information is required on an annual basis.

Transportation Request Form

Student Name:

First:*

Last:*

DOB:*

Grade/Teacher:*

Parent/Guardian Name Contact Phone #:*

Parent/Guardian Name Contact Phone #:

Emergency Contact Person #1 and Phone:*

Emergency Contact Person #2 and Phone:*

I will be transporting my child to and from school.

I will be transporting my child to school in the mornings only.

I will be transporting my child home in the afternoons only.

I want my child to ride the bus.

Morning Pick Up

Please write the address where your child is to be picked up. Monday - Friday.

Afternoon Drop Off

Please write the address where your child is to be dropped off. Monday - Friday.

Date:*

Effective Date:*

Parent / Legal Guardian Signature (use mouse) *

Before submitting this form, please check your answers. Any questions with a red * are required. After submitting the form if you get a validation error, please look for and complete any questions/fields that turn red.

Address and Destination in Event of Emergency School Closing or alternate arrangements:

Address:

Pick up Nickname:

Address:

Drop off Nickname: