Lecanto Transportation Registration Form

New or Updated Information for Students

				Stop Location: AM Stop Location: PM
The following information is needed to assist us in assigning your child to a school bus route. This form must be completed prior to assigning new students to a bus, or changes are made for students currently assigned. The transportation office will assign students to the closest available stop upon receipt of this form. If a stop is more than .5 miles from home or if the walk route to the stop appears unsafe, a bus stop change request can be submitted. All specialized transportation needs as determined by the IEP team will be sent on the Special Needs Transportation Form. If you have any questions please contact the transportation office. Crystal River Transportation 795-4032; Inverness Transportation 344-2193; Lecanto Transportation 746-0682.
**Note: Parent or guardian must be at the bus stop morning and afternoon for Pre-K and Kindergarten. Students will be returned to school if the adult is not at the stop.

Check appropriate box:	Information is for new student			Update for current student

Date:
Student Name:					Date of Birth:
School:			Grade:		Teacher:
Parent or Guardian:			Home Phone:		Work Phone:
Address:				City:		Zip Code:
Student is:	Car Rider	Bus Rider	If student is a bus rider please complete next section.
Subdivision:				Cross Streets:
Directions to your home from zoned school:
School bus stops will be assigned based on the address you have provided above. If pick up or drop off is needed at a care provider in-zone location please provide detailed information.
Emergency medical information (list any health concerns or medication the driver should be aware in case of an emergency.)

List family members or other emergency contact authorized to pick up your child if you are not available: (Picture ID is required.)

1.	Phone:		Relationship:
2.	Phone:		Relationship:
3.	Phone:		Relationship:
Can this student participate in any food-based treats/rewards?		Yes	No
If yes, please list all food allergies
Parent Signature: By submitting this form electronically, you are giving your permission. YOUR SIGNATURE SIGNIFIES YOU HAVE READ AND REVIEWED THE RULES WITH YOUR STUDENT(S).