MIDDLETOWN SCHOOL DISTRICT

REQUEST FOR TRANSPORT TO/FROM CHILD CARE

DATE OF APPLICATION:

STUDENT’S DETAILS: PARENT’S/GUARDIAN’S DETAILS:

Name Name

Address Home Phone #

Work Phone #

Grade (State if AM-K or PM-K) Cell Phone #

CHILD CARE PROVIDER DETAILS: Emerg. Phone #

Name

Address

Phone #

Transportation is requested : To school From school

Start date for transport (please allow 5 working days)

Parent/Guardian signature:

Rules for child care requests:

1. Only child care providers located within the same school zone of attendance as the student’s residence can be considered.
2. Requests can be denied if the school bus you are requesting is full or if there has been a discipline problem.
3. If the bus becomes overcrowded during the school year, because new students move into the district, or there is a discipline problem child care requests can be rescinded.
4. Students must go to the same child care both a.m. and p.m.
5. All kindergarten students must be met at their bus stop daily by a responsible adult.

Submit form to: Mid-City Transit

P.O. Box 202, Middletown NY 10940

Fax: (845) 343-7717

FOR OFFICE USE ONLY:

Dear Parent/Guardian,

Your request for transportation to/from Child Care has been:

Accepted

Denied Reason

The arrangements are: A.M. Route# Bus stop Time

P.M. Route# Bus stop

This will be effective from (date)