MIDDLETOWN SCHOOL DISTRICT

REQUEST FOR TRANSPORT – PAROCHIAL/PRIVATE SCHOOLS

DATE OF APPLICATION:

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

Name Name (Print)

Address Home Phone #

Work Phone #

School Cell Phone #

Date of Birth Emerg. Phone #

Grade for 2006/7

Parent/Guardian signature:

Rules for transport to Parochial/Private Schools:

1. This form must be received by Mid-City Transit Corp. no later than April 1 every year for the coming school year.
2. Submitting this request does not guarantee transportation. Final decision will be made by the Transportation Department of The Enlarged School District of Middletown.
3. Transportation is not available for students residing less than 1 mile from their school of attendance.
4. This request remains effective for the school year. Mid-City Transit must be notified of any changes.
5. All kindergarten students must be met at their bus stop daily by a responsible adult.
6. Provision for transport to/from child care can be made on a separate request form, to be submitted to Mid-City Transit Corp.

Submit form to: Mid-City Transit Corp.

PO Box 202, Middletown NY 10940

Fax: (845) 343-7717

Arrangements for transportation will be mailed to the home address by the end of August 2004.

FOR OFFICE USE ONLY:

A.M. Route# Bus stop Time

P.M. Route# Bus stop