Belfry High School -- Bus Transportation Parental Assurance for Daily Student Health Assessment For School Year 2020-2021
Please complete one form for EACH student.  If you have students attending a different school, please use the form for that school.
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Student Last Name *
Student First Name *
Student Middle Name
Grade Level *
Bus Number (if known)
Street Address *
Signature
By typing my name below, I agree to the above conditions. This form allows students to board the school bus without a temperature check
Parent / Guardian Signature (Type Full Legal Name) *
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