2023-24 Non Public Transportation Plan Form 
If your student lives in Piqua City School district and is attending Christian Academy Schools of Sidney, Lehman Catholic High School, Piqua Catholic and St Boniface, you will need to fill out this form by August 1, 2023.  

If you have any questions, please contact the Transportation Department at 937-773-1560.  Thank you!

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Student First Name: *
Student Last Name: *
Student Birthdate: *
MM
/
DD
/
YYYY
Does student have any health or behavior concerns that Piqua City Schools Transportation Department should be aware of? *
If you answered yes, please explain here:
Student School of Attendance: *
Student Grade for 2023-2024: *
Student Residential Address: *
Student Residential City: *
Student Residential Zip Code: *
Student Parent/Guardian #1 Name: *
Student Parent/Guardian #1 Phone Home/Cell Number: *
Student Parent/Guardian #1 Phone Work Number:
Student Parent/Guardian #1 Email Address:
Student Parent/Guardian #2 Name: *
Student Parent/Guardian #2 Phone Home/Cell Number: *
Student Parent/Guardian #2 Phone Work Number:
Student Parent/Guardian #2 Email Address:
Does student need transportation TO school: *
Where does your student need transportation from (AM-going to school)  Example:  Home, Sitter, Court Ordered Shared Parenting
If you selected a Sitter, please provide Name, Address and Phone Number
Does student need transportation FROM school: *
Where does your student need transportation to (PM-going from school)  Example:  Home, Sitter, Court Ordered Shared Parenting
If you selected a Sitter, please provide Name, Address and Phone Number
Form Submission Contact
Who is submitting this form?
Form Submitted By: *
If submitted by OTHER, provide additional contact information here.  (Contact Name, Phone Number AND Email)
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