* Required

CONRAD WEISER AREA SCHOOL DISTRICT

TRANSPORTATION REQUEST

for

DAYCARE/ALTERNATE STOP CHANGE

Student ​​Last Name​
Student First Name​
Parent Last Name​​
Parent First Name​
Home Address​​
Phone Number​
Email Address
Daycare Provider​
Daycare Address
Daycare Phone Number​
Starting Date​

I understand that my request for an alternate stop is considered permanent, any change will require a new request form and must be submitted a minimum of 48 hours prior to the effective date.I also understand that my child’s pick up and drop off must be at the stop/s indicated above.

Parents Initials
Date

NOTE: It is the recommendation of the Conrad Weiser Area School District that all young children have a parent or designated adult accompany them to and from the bus stop.If you have made arrangements for your child to leave with an alternate source, ie. another child, or sibling, please send a note documenting the person or person’s that may receive and or accompany your child from the stop.

Any questions or concerns regarding this form can be addressed by the Conrad Weiser School District Transportation Department.