25-26 Alternative Pick-up or Drop-off Form

Alternative Pick-up or Drop-off Form

This request form is used for eligible bus riders that would like to request a different location to be picked up or dropped off. The requested address must be on the route serving the student's school. *Note: The request will only be considered for all school days- not alternating days or locations.
A seperate form is required for each student
Student Name*

First NameLast Name
Student ID Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian*

First NameLast Name
Parent/ Guardian Phone Number*
Please enter a valid phone number.
Parent Email Address*
example@example.com
School Attending*

This location is requested for:*

Pick-up ONLY (Going to school)Drop-off ONLY (After school)BOTH Pick-up AND Drop-off (only location for bus transportation)
Alternative Pick-Up or Drop-off Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Adult Responsible for Student At This Alternative Address*

First NameLast Name
Contact Phone Number
Please enter a valid phone number.
Name of Daycare Center (if applicable)

The Pick up / Drop off location requested is along the regular route and to the same school that your student would attend if transported to/from his or her residence.

YesNo (Your application will NOT be considered)
The residence of the child care provider (alternate location) is within walking distance, with no intervening safety hazard areas, of the bus route and stop serving your child’s school.

YesNo (Your application will NOT be considered)
I understand that participation shall be contingent upon availability of seat space on the bus route and will terminate in the event that any information provided is found to be misleading or false. A new form must be completed annually or if a change is requested.

YesNo (Your application will NOT be considered)
I understand that the Pick up/Drop off location can be separate locations. However the location must be the same Monday-Friday, 5 days per week.

YesNo (Your application will NOT be considered)

Please read the following:
- In signing up for this program, you will be waiving and releasing all claims for injuries that might be sustained or arising out of participation in the program.
- The undersigned hereby request that School District 308 allow the student to participate in the Alternate Pickup / Drop off program (the “Program”). Under the program, the student will be transported daily to an alternate location rather than the student’s home address area at the beginning and/or end of each school day.
- The undersigned represents and warrants that the student will be met and custody of the student will be assumed by a responsible adult at the alternate location.
- The undersigned hereby agrees to waive and relinquish all claims including injury; death, damage or loss the undersigned or student may have as a result of participating in the program against the School District, its officers, agents, servants, and employees.
- An Alternative Pick up/Drop off form is subject to bus availability, pick up/drop off locations, and an ongoing review of availability. Past privileges do not guarantee future privileges from one year to the next. Open, available seating on existing bus routes is the primary factor in determining if ridership is available.
Please Acknowledge Below:*

I agree to the above conditions
Type your full name below:*

Include a copy of driver’s license or state ID for both the Parent/Guardian and Day care provider (responsible adult at alternative location).
Upload a copy of a valid Photo ID for the Parent/Guardian:

Cancelof
Upload a copy of a valid Photo ID for the Responsible Adult at Alternative Location:

Cancelof
If you are unable to upload the files, you must email a copy of the photo ID with the student's name and ID number to: busroutes@sd308.org. Your application will NOT be considered until this is received.

I give my permission for my child to ride a School District 308 or contractor provided bus. I understand my child must walk to an existing bus stop, and I assume full responsibility for my child getting to and from the bus stop safely. I further understand if my child misbehaves or if space is needed for an eligible bus student, my child will lose bus ride privileges.
Parent/Guardian Signature

Clear
Date

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Date
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