Student Transportation Registration Form – Loyalsock Township School District

Student Transportation Registration

Please complete all applicable sections and submit in order to register for bus transportation. By submitting this form, you are confirming that you are requesting bus service for the listed student(s) and that you will review the Bus Conduct Rules with the student(s).

Student Information

To add other students, click the plus icon at the end of the row.

Student Name

First

Last

School

Grade *

Parent Name *

Primary Address *

Parent/Guardian Phone Number *

Parent/Guardian E-mail Address

Transportation Needs

Please check the appropriate box to indicate need.

BOTH AM & PM

AM ONLY

PM ONLY

Additional Information for Transportation Director

Loyalsock Township School District requires the parties to certify the application by submitting an electronic signature. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. *

I agree

By signing this form, you are confirming your request bus service for your student(s) entered above. You are also stating that you will review the Bus Conduct Rules with your student(s). *

Please type your first and last name

Date