TRANSPORTATION APPLICATION ELKHORN PUBLIC SCHOOLS 20650 GLENN STREET ELKHORN NE 68022 2016 – 2017

Name of Student(s) Grade School Bus/Rte # (Same)

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Home Address: ______Phone ______

*Subdivision ______City ______Zip ______

Parents/Guardian ______Please print first and last name

MARK ALL THAT APPLY!!!!!! _____ We live 4 miles or more from our student’s school building; so according to State Law and Board Policy we qualify for free bus service.

_____ We live less than 4 miles from our student’s school building; so we agree to pay Chief School Bus Service, 3111 South 67 Avenue, Omaha NE 68106 the monthly charge of $44.70 one-way per child, or $78.65 round trip per child. Family discount for round trip of $5 per month for the second child riding from the same family, $10 per month for the third child riding from the same family and free transportation for the fourth or more child riding from the same family. Family discount for one way is $2.50 per month for the second child riding from the same family, $5 per month for the third child riding from the same family and free transportation for the fourth or more child riding from the same family. (Mail your check to Chief Bus Service, 3111 South 67th Avenue, Omaha NE 68106 – Do not sent to the school.)

_____ We qualify for free or reduced price lunches and are requesting a waiver of bus fees. We authorize school officials to share information from our Free and Reduced Price School Meal Application to receive this waiver.

_____ Call George at 402-392-2144 at Chief Bus Service if you have any questions concerning pick up place and approximate time. Otherwise, call Debbie at 402-289-2579, ext 10007. You can fax application to: 402-289-2585, or e- mail it to [email protected].

_____ We have read and discussed the expectations for those who ride the buses provided by the Elkhorn Public Schools. We realize that bus riding privileges may be revoked if the student(s) does not behave according to the behavioral expectations described in the transportation brochure entitled “The Ride Guide.”

______Parent/Guardian Signature Date

*PLEASE MAKE SURE YOU HAVE FILLED OUT THE ENTIRE APPLICATION INCLUDING THE SUBDIVISION YOU LIVE IN AND THE BUS/ROUTE NUMBER THIS FORM WILL NOT BE ACCEPTED UNLESS IT IS COMPLETELY FILLED OUT