Specialized Transportation Application
Students must be pre-approved for Specialized transportation.
Student Details
Student's name
*
First Name
Last Name
Student's birthdate
*
-
Year
-
Month
Day
Date
Student ID
*
9 digit Learning ID
Student's school
*
Please Select
Deshaye
Sacred Heart
St. Bernadette
St. Catherine
St. Dominic
St. Francis
St. Jerome
St. Joan of Arc
St. Luke
St. Marguerite
St. Maria Faustina
St. Matthew
St. Raphael
St. Timothy
LeBoldus high school
Riffel high school
Miller high school
St. Gregory
Student's grade
*
Please Select
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Student's program
*
Please Select
EISC (elementary)
FIP or Alt Ed (high school)
K-inclusion
St. Maria Faustina
St. Luke
Other
St. Luke integration - school staff only
Back
Next
St. Luke Integration
For completion by school staff only.
Home/catchment school
Please Select
Deshaye
Sacred Heart
St. Augustine
St. Bernadette
St. Catherine
St. Dominic
St. Francis
St. Gabriel
St. Gregory
St. Jerome
St. Joan of Arc
St. Josaphat
St. Kateri
St. Marguerite
St. Matthew
St. Michael
St. Nicholas
St. Peter
St. Theresa
St. Timothy
Integration schedule requested
Include dates and times
Requested start date for integration:
*
-
Year
-
Month
Day
Date
Is this only a change in integration transportation?
Yes. If yes, select Submit below.
No. If no, select Next below and continue with the rest of the form.
Back
Submit
Next
Safety and Equipment
Student release
*
My student may be released without a responsible adult coming to the vehicle. I understand they will be observed entering the school or residence before the driver leaves.
My student will always be met and unloaded from the vehicle by a responsible adult in a timely manner.
Equipment student utilizes. Family is to provide all required equipment.
*
Booster seat (as per current SGI regulations)
Car seat or 5 point harness (as per current SGI regulations)
Angel Guard. Permission form must be completed by family or guardian.
My child will be transported in their wheelchair.
None of the above
Back
Next
Contacts and Transportation Address
Parent/guardian #1
Parent/guardian #1 name
*
First Name
Last Name
Parent/guardian #1 primary phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/guardian #1 email
*
example@example.com
Parent/guardian #1 street address
*
eg. 123 Albert Street, Unit 1
Parent/guardian #2
Parent/guardian #2 name
First Name
Last Name
Parent/guardian #2 primary phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/guardian #2 email
example@example.com
Parent/guardian #2 street address, if different than parent/guardian #1
eg. 123 Albert Street, Unit 2
Child care provider - only if transported from
Child care provider's name
First Name
Last Name
Child care provider's street address
eg. 111 Lewvan Drive, Unit B
Schedule
Schedule
Requested start date:
*
-
Year
-
Month
Day
Date
Student's school attendance schedule:
*
Please Select
Attends all day
Attends mornings only
Attends afternoons only
Other (provide details below)
Attendance schedule details
Include dates and times.
Before school pickup location:
*
Please Select
Parent/guardian #1
Parent/guardian #2
Child care provider
Pickup not required/Family will transport
Select one location or indicate if you will take your child to school
After school drop off location:
*
Please Select
Parent/guardian #1
Parent/guardian #2
Child care provider
Drop off not required/Family will transport
Select one location or indicate if you will pickup your child from school
Additional Information (medical information or notes that may be relevant to the safe transportation of your child and all occupants)
Specialized Transportation Services Agreement
Please review the Specialized Transportation Guide for protocols and procedures.
Specialized Transportation Services agreement:
*
I will contact the service provider before 7 am or as soon as possible for any instances that my child will not be using the van, both before and after school.
I will complete a new application and/or contact the RCSD transportation office if we no longer require van service or if our transportation needs change.
I acknowledge that transportation protocols and procedures apply, and we will adhere to them.
Submit
Should be Empty: