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STUDENT TRANSPORTATION FORM
Clark County Public Schools
PARENT SECTION
Todays Date:
/
Month
/
Day
Year
Date
Student's Full Name:
First Name
Middle Name
Last Name
Student's DOB:
*
/
Month
/
Day
Year
Date
School:
*
Please Select
GRC
Phoenix
Campbell
Baker
Conkwright
Justice
Shearer
Strode Station
Preschool
Grade:
*
Please Select
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Other
Parent/Guardian Name:
*
Parent/Guardian Phone:
*
Format: (000) 000-0000.
Home Address:
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Has your information changed since last school year?
*
YES
NO
If your morning pick-up address and/or afternoon drop-off address is DIFFERENT from your Home Address above, please complete the next two boxes. Otherwise, skip to the "Special Requirements" section.
Morning Pick-up Street Address:
Afternoon Drop-off Street Address:
Special Requirements
Check all that apply:
Lift
Medication
Special Harness
Supervision required by Monitor
Other
Details about Special Requirements and/or Identify Need:
Committee Meeting Date:
/
Month
/
Day
Year
Date
Committee Meeting Chair:
Thank you, Parent/Guardian! Please click the "Submit" button below to send us your form.
Submit
TRANSPORTATION DEPT. USE ONLY
Morning Bus #
Morning Bus Pick-up Time:
Stop Location:
Afternoon Bus #
Afternoon Bus Pick-up Time:
Stop Location:
Transfer Bus #
Transfer Point:
Form Completed By:
Date:
/
Month
/
Day
Year
Date
Should be Empty: