1. KESHEQUA TRANSPORTATION DEPARTMENT
    2. PLEASE PRINT !!!


KESHEQUA TRANSPORTATION DEPARTMENT



KESHEQUA TRANSPORTATION DEPARTMENT
 
 

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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