KESHEQUA TRANSPORTATION DEPARTMENT
KESHEQUA TRANSPORTATION DEPARTMENT
Deadline: September 30, 2004
Deadline: September 30, 2004
Directions: This form is required for all students. Please fill out this transportation form and return it to:
The Keshequa Transportation Department, P.O. Box 517, Nunda, NY 14517
PLEASE PRINT !!!
PLEASE PRINT !!!
DATE ___________________________________ EFFECTIVE DATE _______________________________
CHILD’S NAME ______________________________________________________________ GRADE _____________________
(H) __________________
HOME ADDRESS _____________________________________________________________Phone (W) __________________
(H) __________________
EMERGENCY CONTACT: Name _______________________________________________ Phone (W) __________________
PARENT / GUARDIAN SIGNATURE _________________________________________________________________________
************************************************************************************************************************
If transportation is the SAME FOR EVERY DAY, please complete this section of the form.
BEFORE SCHOOL ARRANGEMENT AFTER SCHOOL ARRANGEMENT
_________________________________________ ________________________________________
pick-up location drop-off location
_________________________________________ ________________________________________
address address
************************************************************************************************************************
If transportation CHANGES FOR ANY DAY DURING THE WEEK, please complete this section of the form.
BEFORE SCHOOL ARRANGEMENT AFTER SCHOOL ARRANGEMENT
MONDAY _______________________________________________ ________________________________________________
pick-up location drop-off location
_______________________________________________ ________________________________________________
address address
TUESDAY _______________________________________________ ________________________________________________
pick-up location drop-off location
_______________________________________________ ________________________________________________
address address
WEDNESDAY ___________________________________________ ________________________________________________
pick-up location drop-off location
_______________________________________________ ________________________________________________
address address
THURSDAY _____________________________________________ ________________________________________________
pick-up location drop-off location
_______________________________________________ ________________________________________________
address address
FRIDAY ________________________________________________ ________________________________________________
pick-up location drop-off location
_______________________________________________ ________________________________________________
address address
Reminder: This transportation schedule must remain consistent throughout the school year.
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