By Cynthia Taylor,2014-08-28 21:22
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    School Year: 200 / 200

     New Change (please circle the change on form) Cancellation Empty Seat

     Empty Seat-Principal Signature ____________________ School Bus Wheelchair Bus TTC PARENT USE Please complete this section, Page 2 and return to school

    Student Surname: First Name: Health Card Number:

    Date of Birth: dd mm yy Parent / Guardian E-mail Address(es): (if available) Male Female Home Address: Postal Code: Home Phone: Apt. #:

Mother/Legal Guardian Name: Business Phone:

    Business Phone: Father/Legal Guardian Name:

    Emergency Contact: Phone: (Ensure emergency contact is someone other than parent)

     Transportation location for pick up prior to school: School/Stop pick-up or drop-off for Regular, French Immersion or Gifted students

     Transportation location for drop off at dismissal:

     Page 2 SCHOOL USE ONLY Please complete this section and fax to Transportation Office (416) 394-3806 Destination School Name: School Address: Phone Number:

    School Code: Program: Program Code: Trillium #: Grade:

     Accurate Bell Times are Imperative Class Start Time: Class Dismissal Time: Program Specifications (please provide days and times):

    Date Transportation to Begin: End Date:

Special Transportation Requirements/Instructions:

    (i.e., Individual Transportation re Behaviour/Health; Car Seat; Safety Vest; Accompanied by nurse or other;

    If the student requires school bus transportation outside the Policy, at what cognitive grade level does he/she function? __________________ __________________ _________ Signed by