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 !!!

 

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

 

 

_________________________________________

________________________________________

pick­up location

drop­off 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

_______________________________________________

________________________________________________

pick­up location

drop­off location

 

_______________________________________________

________________________________________________

address

 

address

 

TUESDAY

_______________________________________________

________________________________________________

pick­up location

drop­off location

 

_______________________________________________

________________________________________________

address

 

address

 

 

WEDNESDAY

___________________________________________

________________________________________________

pick­up location

drop­off location

 

_______________________________________________

________________________________________________

address

 

address

 

 

THURSDAY

_____________________________________________

________________________________________________

pick­up location

drop­off location

 

_______________________________________________

________________________________________________

address

 

address

 

 

FRIDAY

________________________________________________

________________________________________________

pick­up location

drop­off location

 

_______________________________________________

________________________________________________

address

 

address

 

Reminder: This transportation schedule must remain consistent throughout the school year.

 

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