1.	Child's Last Name*

2.	Child's First Name*

3.	Child's Street Address*

4.	City, State, Zip*

5.	Parent/Guardian Name*

6.	Contact Phone Number*

7.	Child's Grade*

8.	Email Address

9.	Names of brothers and/or sisters

10.	Do you need bus transportation in the morning?*
	No in the morning    Yes in the morning from home    Yes in the morning from alternate stop

11.	If requesting an alternate morning stop, please enter the name and address of the before school provider.

12.	Do you need bus transportation in the afternoon?*
	No in the afternoon    Yes in the afternoon to home    Yes in the afternoon to alternate stop

13.	If requesting an alternate afternoon stop, please enter the name and address of after school provider.

14.	If transferring from another school, name of current school.