Ulster - Transportation Request Form
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  • Transportation Request Form

    Preschool Only for Ulster County

  • Privacy Policies

    For more information on the privacy policies of Jotform and Ulster County please click on the following:

    Jotform Privacy Policy
    Jotform Security
    Ulster County Privacy Policy
    Ulster County Notice of Privacy Practices

  • I am requesting transportation for:*
  • Type of transportation requested*
  • Request is for:*
  • Requested Start Date*
     - -
  • Change is (check all that apply)*

  • Child's Information

  • Date of Birth*
     - -
  • Gender*
  • Is the Mailing Address different from Home Address?*

  • Parent/Guardian Information

  • Parent/Guardian #1

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do you wish to add a second parent/guardian?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Complete this section ONLY IF your child is to be picked up or dropped off at an address other than the home.

    Temporary Changes Will Not Be Granted

  • This request is for:

  • Emergency Contacts

  • For the safety of your child, Ulster County requires a minimum of two (2) emergency contacts to whom we may release your child in case we are unable to reach you in an emergency or in case you are unable to meet the bus. Emergency contacts must have transportation and must be sixteen (16) or older and must have a physical, valid form of photo identification (i.e., school/work/state ID, passport, driver’s license, etc.) to present in order to receive your child from the bus. The police department will be notified as a last resort.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Persons authorized to receive child from bus

  • Persons who may NOT receive your child 

  • In accordance with the State Education Department Office of Vocational and Educational Services for Individuals with Disabilities, Regulations of the Commissioner of Education, Pursuant to §207, §3214, §4403, §4410 of the Education Law, Part 200 Students with Disabilities §200.16 (e)(5): In developing its recommendation for a preschool student with disability programs and services, the committee must identify transportation options for the student, and encourage parents to transport their child at public expense where cost effective.

    When making a selection for Parent Transport, I understand that no exceptions will be made to my selection below (Please refer to the Parent Handbook).

  • Please check one:*

  • If PMR is selected, Prismatic will send you a PMR packet with further information.

  • Signature Page

  • Both Signatures are Required to Validate This Form

  • Date*
     - -
  • Date
     - -
  • Should be Empty: