Forms PSSD CharterRequest

Bus Charter Request Form

Trip Date

School

Destination

Itinerary

Destination Addresses

Departure Time

Departure Time for Return

Grade(s)

No. of Students (Pre-K-Gr 3)

No. of Students (Gr 4-12)

No. of Additional Passengers

Is the Driver to stay with the group? This field is required.

Yes

Optional

A budget code is missing.

Decentralized Budget Code

1-2-14-175-522-

-000-000

Centralized Sport (i.e. autorized league games)

1-2-14-175-522-207-831-

Centralized Other (Must specify)

School Generated Funds (Specify)

1-2-16-

-4

-000-000

School Assigned Budget (Specify)

Chaperone/Coach

Emergency Ph. No

Driver Assigned

Note

Bus Assigned

TRANSPORTATION DEPT. USE ONLY

Driver Wages

Driver Standby Time

Standby Time

Driver Exp./Meals

Charge to School Account

Submitted by

Last Name

First Name

Confidentiality Statement In accordance with the Personal Information Protection and Electronic Documents Act, Article 29, Paragraph (2), personal information requested in this form will assist in providing transportation services. The information is gathered in accordance with the Education Act S.R.O. 1980, c. 129, s.166 (1).

Forms PSSD CharterRequest

Bus Charter Request Form

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