Cisd Employee Child Transportation Request Form

CISD EMPLOYEE CHILD TRANSPORTATION REQUEST FORM

As an employee of Channelview I.S.D., I am requesting permission for my child or legal ward to be allowed to ride a bus other than their regularly assigned bus to and/or from school as indicated below. Should any changes occur, I understand that it is my responsibility to notify the Transportation Department immediately to request amendments to this schedule.

Employee’s Name: ______Phone: ______

Employee’s Address: ______

Employee’s Work Location: ______

Employee’s Cell Phone or Pager #: ______

Emergency Contact Person: ______

Emergency Contact Person’s Phone #: ______

Child’s Name: ______

Employee’s Relationship to Student: ______

Grade: ______Age: ______Sex: ______

Campus Attending: ______

Loading Location: ______

Drop off Location: ______

Time of A.M. Loading: ______Bus #: ______

Time of Midday Loading: ______Bus #: ______

Time of P.M. Loading: ______Bus #: ______

Time of Extended Day Loading: ______Bus #: ______

Please circle the days and times that Transportation is requested:

Monday: A.M. MIDDAY P.M. Ext. Day Tuesday: A.M. MIDDAY P.M. Ext. Day

Wednesday: A.M. MIDDAY P.M. Ext. Day Thursday: A.M. MIDDAY P.M. Ext. Day

Friday: A.M. MIDDAY P.M. Ext. Day

Employee’s Signature: ______Date: ______

Principal’s Signature: ______Date: ______

Approved by Coordinator of Transportation: ______Date: ______