Jefferson Bus Service
Transportation Registration Form 2007—2008 School Year
Parent or Guardian Information
Are you new to the Jefferson School District? Yes No
Please indicate the days of the
week your student will be in day
care and if we are to pick them
up at day care and/or drop them
off at day care. For days not
marked, we will assume the
home address.
Jefferson Bus Service will treat all of the above information as Personal and Confidential
And will use it only to help us schedule transportation or in the event of an emergency.
Jefferson Bus Service may also us audio/video recording equipment on any or all of our
vehicles in order to monitor and maintain discipline of both passengers and drivers.
Student Information
First Name: Last Name:
Home Address:
City: State: ZIP:
Home Phone: Work Phone:
Email:
Secondary Contact Person:
Secondary Contact Phone:
Baby Sitter / Day Care Information
Name:
Address:
Phone:
Monday
AM
PM
Tuesday
Wednesday
Thursday
Friday
First Name
Last Name
School
Grade
East Elementary West Elementary Sullivan Elementary Middle School High School St John Catholic St John Lutheran St Peter Lutheran
Pre-Kgn Kgn EC 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th