Bus Request Form 24-25

CHPA Bus Request Form
If your student does not currently ride the bus, but you are interested in bus service, please fill out the request form below. The Transportation Director will contact you if the request has been approved or denied. Please note the bus stops that are scheduled will not be changed; you must select a stop that is closest to you. We make every effort to provide the best bus service we can to all students.

Please fill out the information below for each student.
Example: Bus route: (ES1) Stop: (1)

Please have student at Bus stop 10 minutes before Bus is scheduled to leave.
Student Name
Grade
Bus Route (Letter)
Stop (Number)
Student Name
Grade
Bus Route (Letter)
Stop (Number)
Student Name
Grade
Bus Route (Letter)
Stop (Number)
Student Name
Grade
Bus Route (Letter)
Stop (Number)
Today's Date

MonthDayYear
Date
Parent/Guardian
Phone
Address
Cell Phone
Email
example@example.com
City
Zip
If not able to pick up my student(s) at the designated time at the bus stop.(check one)

____ My student(s) are allowed to walk home by themself.

____ My students(s) are allowed to walk home with siblings.

Name of Sibling(s)______________________________________________
I have the following arrangements for my student(s)
Iunderstand that my student is to follow all safety rules set by the transportation department. Parent or guardian will be held responsible for the cost of repair or replacement of any damage or vandalism to the bus caused by your student.
Parent/ Guardian print name
Parent/Guardian Signature

Clear
Today's Date

MonthDayYear
Date
Should be Empty:

CHPA Bus Request Form