Bus Program

Where we can make a difference

Bus Program Reservation Form

2018 - 2019 Academic Year

* indicates required field

Student Name:*

Grade:*

Address:*

City:*

Postal Code:*

Res Phone:

Bus. Phone:

Cell Phone:

Emergency Contact:

Please indicate the type of service required:*

AM onlyPM onlyAM & PM

The nearest intersection to my home is:*

The nearest MAJOR intersection to my home is:*

Payment Plan:*

AdvancedMonthly

Payment Method*

ChequeVISA/MC

I am the parent/legal Guardian and authorized person over the student mentioned above.

I authorize the following to pick up/drop off the student mentioned above from the school bus:

Name(1):

Relationship:

Name(2):

Relationship:

Name(3):

Relationship:

Does your child have a medical condition?*

YesNo

If yes, please indicate:

Health Card Number:*

Expiration Date:*

Your name:*

Your E-mail address*

Confirmation Email