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Child Care Provider Form

Please fill out the form below to have your child picked up and dropped off.

Your e-mail address
Student's Name
Grade
Home Street Address 1
Home Street Address 2
Home Apartment
Home Phone
Parent's/Child Care Provider's
Name
Parent's/Child Care Provider's
Street Address 1
Parent's/Child Care Provider's
Street Address 2
Parent's/Child Care Provider's
Apartment
Parent's/Child Care Provider's
Phone
Person of Contact
Student will be picked up
and dropped off at:
OR
Student will be picked up
here only:
Student will be dropped off
here only:
AND
1/2 day or early dismissal
drop off child at:
Emergency Contact 1 Name:
Emergency Contact 1 Phone:
Emergency Contact 2 Name:
Emergency Contact 2 Phone:
Students will be picked up/dropped off at the closest designated stop to the sitter. Transportation Department needs approximately 72 hours notice in order to make changes to your child's transportation needs. The sitter stop will become your child's assigned stop.

By clicking the submit button below, you confirm the information on this form is accurate and reflects your consent to have the above actions taken as stated.
Parent/Guardian name as signature:
Date: