One Day Transportation Change

NEWARK CENTRAL SCHOOLS REQUEST FOR A ONE DAY CHANGE IN TRANSPORTATION FORM For the safety and security of all children riding buses to and from school, we require that any changes to the daily routine of a child’s busing be made in writing by the parent or guardian of that child. We will not accept changes regarding busing by phone call only. The written request may be sent to school with your child, dropped off during the day to the main office or it can be emailed to the school.

1.	Student's Name*

2.	SCHOOL*
	SCHOOL* Kelley School Lincoln School Perkins School

3.	Grade*

4.	Present Bus Number*

5.	Present Bus Stop*

6.	Change to Bus Number*

7.	Change to Bus Stop*

8.	Requested Date(s) of change*

9.	Reason for Change Request*

10.	Parent/Guardian Name(s) Completing Form*

11.	Relationship to child*

12.	Cell phone number*

13.	Email

14.	Electronic Parent/Guardian Signature*

15.	Date*
	mm/dd/yyyy

	For Office Use Only: Date Received: _____________________ Request Approved: _____________________ Request Denied: ___________________ Date of Implementation: _________________ School Office Signature: _______________________________________________Date: ____________________ Director of Transportation Signature: _______________________________________________Date: _____________________