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Bus Stop Request
INSTRUCTIONS: To be completed by parent/guardian and returned to the school administration office. Please allow for a delay of five business days (or 10 business days in September) from date of receipt for the requested change to come into effect.
District
--Select--
Dufferin-Peel Catholic DSB
Other Schools
Upper Grand District School Board
Wellington Catholic District School Board
School
Grade
Student Last Name
Student First Name
Gender
--Select--
F
M
N
S
X
Birth Date
Student ID
Alternate ID
More than one student matches the criteria submitted. Please select the student to use
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Section I – Request Type
Shared custody
More secure bus stop
Courtesy seating
Section II – Reason for Request
Comments
Length of trip
Walking distance
Unsafe Location
High-traffic area
Other
Other
Section III – Student Information
Home Address
House/Apt. number
Street name
Suffix
City/Town
Postal/Zip Code
Telephone (home)
Telephone (mother / guardian)
Telephone (father / guardian)
Morning Pickup Address
Same as home address (see above)
If address is different, please complete the section below
House/Apt. number
Street name
Suffix
City/Town
Postal/Zip Code
Nom de la personne contact
Numéro de téléphone
Numéro de téléphone alternatif
Afternoon Drop-off Address
Same as home address (see above)
If address is different, please complete the section below
House/Apt. number
Street name
Suffix
City/Town
Postal/Zip Code
Contact name
Contact Phone
Contact Phone (alternate)
Submitted by
I acknowledge that transportation procedures will apply.
Last Name
First Name
Email
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