Transportation Exception / Parent Release

Required

You must complete a request form for each student.

Student Namerequired

First Name

Last Name

Street Addressrequired

Example: 4924 Orchard Lake Rd

City, State, & Zip Coderequired

Example: West Bloomfield, MI 48324

Phone Numberrequired

School of Attendancerequired

1 school per form.

Transfer Request Confirmationrequired

I am requesting that my child take a different bus to and/or from home other than the assigned bus route.

In the space below, please describe transporation request.required

Guardian Consentrequired

I authorize the following person(s) to receive my child(ren) at the bus stop:

Pick-Up Personrequired

First Name

Last Name

Phone Number - Pick-Up Person

Alternate Pick-Up Person

First Name

Last Name

Phone Number - Alternate Pick-Up Person

Pick-Up Committmentrequired

We need you or a listed pick-up person to be present and on time when receiving your child(ren). Students that have no adult present to meet them at the bus will lose their riding privileges.

Parent Consent Authorizationrequired

Checking this box will serve as my digital signature and authorization.

Your NamerequiredThis form must be completed by the Parent or Legal Guardian on record for listed child(ren).

First Name

Last Name

This form must be completed by the Parent or Legal Guardian on record for listed child(ren).

Parent Email Address (to contact you regarding this form)required

New bus stops will not be created, nor will bus routes be altered to satisfy individual needs.

You will be notified of bus stop information once the form is processed. If you have questions, please contact the Transportation Department at (248) 865-3680.

Please consult the West Bloomfield School District for information regarding student behavior, the Transportation Handbook and Bus Zone.