Non-Primary Transportation Request

Out of Area Safe Location Request
FormTitle
This form is to request transportation services to a Safe Haven location. The location of the Safe Haven must be a current registered stop or collection point where services occur most school days and can be reasonably accommodated on the existing bus service. The schedule must be consistent and predictable. Alterations to the route will not be approved.
- This section is for the student’s primary information, including home address and parent/guardian details. If this information does not match what the school has on file, the application process may be delayed.
- Student Name*
- Student ID Number*
  Acquired from the School
- Primary Address*
- Requestor Email Address*
  example@example.com
- Parent Name*
- Requestor Contact Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- School Attending*
- School Form
- Grade*
- Grade Form
- Transportation Start Date*
  
  MonthDayYear
  Date
- Host Family Information
- Please ensure you enter the correct email address for your host family, as they will receive a form to complete and sign. Let them know to watch for an email requiring their immediate attention. The transportation request cannot be completed until both sections are filled out and signed. Missing information may delay the application process.
- Host Name*
  
  First NameLast Name
- Host Email*
  example@example.com
- I understand that this form must be completed and submitted annually. I understand that transportation will no longer be provided for my child/children if there is no longer available capacity on the bus, if the alternate stop location is no longer a registered stop or the host family no longer permits the service to their residence. I understand that approval for this service may be rescinded by Prairie Spirit School Division at any time.
- Signature of Parent Guardian*
  
  Clear
- Date
  
  MonthDayYear
  Date
- WAIVER FOR KINDERGARTEN STUDENTS ONLY
- Kindergarten students must be met at their designated bus stop by an adult. If such arrangements are not possible then the waiver below must be signed. Students not met by an adult without the waiver signed will be returned to their school and parents/ guardians will be responsible for picking the student up at the school.
- Please allow the above kindergarten student to be dropped at the stop without an adult to meet them.
- Parent Legal Guardian Signature
  
  Clear
- I confirm that I have given approval to the above named family to access bus transportation services to/from our residence. I also acknowledge responsbility for the child when they are delivered to my care at my residence indicated below or associated collection point. I am able to discontinue the service to the family at any time by notifiying Prairie Spirit School Division Transportation
- Host/Homeowner Name*
- Host Contact Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Urban Civic Address
- Host Email Address
  example@example.com
- Bus Route Number
- Rural Legal Land Description Address:
- Section
- Township
- Range
- Meridian
- Signature of Host Family*
  
  Clear
- Date
  
  MonthDayYear
  Date
- Please allow up to seven (7) business days to process and possibly longer in August, September & October. Delays will occur if information is not legible and/or incomplete.
- Should be Empty:

Out of Area Safe Location Request

Host Family Information

WAIVER FOR KINDERGARTEN STUDENTS ONLY