doc2005-2006 forma de transportacion
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2005-2006 forma de transportacion
J.O. Combs Unified School District #44 TRANSPORTATION FORM (Please print legibly. All information is required.) Ellsworth Elementary Jack W. Harmon Elementary J.O. Combs Middle School Combs High School Ranch Elementary Kathryn Sue Simonton Elementary Cougar Cubs Pre-School Little Cougars Pre-K ID# ____________________________ START DATE: _____________________ STUDENT’S NAME: ___________________________________________ LAST ____________________________ FIRST __________________________ MIDDLE HOUSE # AND STREET _____________________________________________________________________ APT. OR SPACE # ______________ MAILING ADDRESS (If different from above) ________________________________________________________________________________________ CITY _____________________________________ STATE _______ ZIP _____________ SUBDIVISION _______________________________ GRADE 09-10 _______ HOME PHONE __________________________ DATE OF BIRTH _______________________ SEX: M F MOTHER: ______________________________________________________ WORK PHONE: ____________________________________ FATHER: _______________________________________________________ WORK PHONE: ____________________________________ EMERGENCY CONTACT NAME: ___________________________________________________ PHONE: _________________________________ CHECK IF TRANSPORTATION IS NOT REQUIRED FOR: AM PM Note: Checking not required for AM or PM above does not make your child ineligible to ride. You may call Transportation to schedule your child on a route at any time. Transportation for students attending on a Boundary Exemption is the responsibility of the Parent / Guardian. ALTERNATIVE TRANSPORTATION INFORMATION – IF NEEDED PICK-UP INFORMATION IF OTHER THAN HOME STOP (ADDRESS OF CAREGIVER OR NAME OF DAYCARE PROVIDER): _________________________________________________________________________________________________________________________ CONTACT PERSON: ___________________________________________________________ CHECK DAYS THAT APPLY: MONDAY TUESDAY PHONE: _________________________________ WEDNESDAY THURSDAY FRIDAY PICK-UP INFORMATION IF OTHER THAN HOME STOP (ADDRESS OF CAREGIVER OR NAME OF DAYCARE PROVIDER): _________________________________________________________________________________________________________________________ CONTACT PERSON: ___________________________________________________________ CHECK DAYS THAT APPLY: MONDAY TUESDAY PHONE: _________________________________ WEDNESDAY THURSDAY FRIDAY Combs & Gantzel Campus OFFICE USE ONLY: DRIVER: __________________________ ROUTE: __________________ P/U TIME: __________________ D/O TIME: _________________ BUS STOP: ______________________________________________________________________________________________________ Send form to Transportation Department Revised 3/5/2009 Page 8 of 8 Distrito Escolar Unificado de J.O. Combs #44 FORMA DE TRANSPORTACIÓN Favor de escribir legible-toda la información es requerida Escuela Primaria Ellsworth Escuela Primaria Jack W. Harmon Escuela Secundaria J.O. Combsl Preparatoria Combs Escuela Primaria Ranch Escuela Primaria Kathryn Sue Simonton Pre Escolar Puma Cachoros NOMBRE DEL ESTUDIANTE: ___________________________________ Pre Kinder Puma Cachoros ____________________________ Apellido __________________________ Primer Segundo NUMERO DE CASA Y CALLE _____________________________________________________________ CIUDAD, ESTADO Y CODIGO POSTAL _______________________________________________ EN DONDE VIVE _________________________ FRACCIONAMIENTO ____________________________________________________________________ TELÉFONO ____________________________ GRADO 09-10 _____________ SEXO: HOMBRE MUJER FECHA DE NACIMIENTO _____________________________ MADRE ________________________________________ TELÉFONO DE TRABAJO _________________________ PADRE _________________________________________ TELÉFONO DE TRABAJO ________________________ INFORMACIÓN ALTERNATIVA DE TRANSPORTACIÓN DIFERENTE DE SU PARADA NORMAL INFORMACIÓN PARA RECOGER (DIRECCIÓN DEL CUIDADOR O NOMBRE DEL LUGAR DE CUIDADO) PERSONA PARA CONTACTAR: ______________________________________________ MARCAR LOS DIAS QUE APLICAN: LUNES MARTES TELÉFONO ____________________________ MIÉRCOLES JUEVES VIERNES ________________________________________________________________________________________________________________________ INFORMACIÓN PARA RECOGER (DIRECCIÓN DEL CUIDADOR O NOMBRE DEL LUGAR DE CUIDADO) PERSONA PARA CONTACTAR: ______________________________________________ MARCAR LOS DIAS QUE APLICAN: LUNES MARTES TELÉFONO ____________________________ MIÉRCOLES JUEVES VIERNES Combs & Gantzel Campus OFFICE USE ONLY: DRIVER: __________________________ ROUTE: __________________ P/U TIME: _________________ D/O TIME: __________________ BUS STOP: _____________________________________________________________________________________________________ Send form to Transportation Department Revised 3/5/2009 Page 8 of 8
