Transportation Child Care Authorization Form printable pdf download

Transportation Child Care Authorization Form

3541 Appendix A

CHILD CARE AUTHORIZATION

I_____________________________ hereby authorize the Bristol Board of

(Parent or Guardians name)

Education to Pick up and/or Drop off my child at the following child care provider.

Student:

School:

Grade:

Parent/Guardian Contact #:

Child Care Provider's Name:

Child Care Provider Address:

Child Care Provider's PHONE NUMBER: ________________________________________

DAYS ATTENDING DAY CARE: ___ MON ___TUES ___WED ___ THUR ___ FRI

PICKUP [a.m.] Address:

DROP OFF [p.m.]Address:

EFFECTIVE DATE: _________________

SCHOOL YEAR_____________

I understand that the pick up and/or drop off address MUST BE ON AN EXISTING BUS

ROUTE for the school year and MUST BE IN MY CHILD'S PUBLIC SCHOOL

ATTENDANCE AREA. I will accept full responsibility for my child when he /she is at this

address.

Please submit this authorization form to the main office at your child's school, and allow 48

hours in change of transportation to take effect.

Any changes to this plan must be made in writing and submitted to the school principal who will

forward it to the Transportation Coordinator.

_______________________________________________________

______________

______

SIGNATURE OF PARENT OR

GUARDIAN

DATE

THIS FORM MUST BE COMPLETED ON AN ANNUAL BASIS, FOR

AUTHORIZATION TO CONTINUE FROM ONE YEAR TO THE NEXT.

Transportation Child Care Authorization Form