Wallkill - PRIVATE/PAROCHIAL TRANSPORTATION REQUEST FORM

To Whom it May Concern:
In accordance with the laws of the State of New York, I hereby formally request transportation for 2024-25 school year:
Name of Pupil pupil name Date of Birth*   Date
to   name of school     county   during the coming scholastic year on all days this school is in session.
The pupil for whom I am requesting transportation will be    years   years of age, will enter    grade   Grade in September and resides at:

Physical Residence (Legal Residence)

Street Address

Street Address Line 2

CityState

Zip Code

Mailing Address (if different)

Street Address

Street Address Line 2

CityState

Zip Code

Home Telephone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Telephone Number

Please enter a valid phone number.Format: (000) 000-0000.

The school to which I request transportation is    miles miles from the student's legal residence.

In addition to making this request directly, I wish to inform you that I have authorized the Principal of    school      School, or his or her successor in that position, to by my representative in requesting transportation for my child.

This authorization shall remain effective while I have my child in attendance at    school   School or unless I expressly revoke this request.

Parent/Guardian Name (Please Print)

Date

Parent/Guardian Signature

Give a description of the route taken from the child's residence to the school.