2023-24 Bus Route/Shuttle Service Form

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PLEASE SUBMIT A SEPARATE FORM FOR EACH STUDENT
The school district does not personalize bus routes/courtesy shuttle service based upon shared custody arrangements, individual sports/activities participation, church or social activities, child care schedules, play dates, or special occasions.
Only one location may be selected for morning and one for the afternoon. Students should ride only their assigned bus and get on/off at the stop selected on this form. This policy will be strictly enforced.
Students are not permitted to ride the bus until this form is submitted, in addition to a signed liability release from the handbook.
The contact number you submit must be on file with the school district.

Authorization *

By submitting this form, I authorize my child to use the school’s bus route or courtesy shuttle service. In authorizing my child to use the school’s bus route or courtesy shuttle service, I understand that supervision is not provided at the shuttle pick-up/drop-off sites and accept all responsibility for the safety and behavior of the student before getting on the school bus and after getting off of the school bus. Parents/Guardians agree to hold harmless Holdrege Public Schools or its employees or agents for any injuries of any kind, or death of any student that might happen because of the alternative transportation pick-up or drop-off.

Required

Bus Rules *

I have read the Bus Route & Courtesy Shuttle Service Rules and understand that my student will be required to follow established rules while riding the bus, and further acknowledge that failure to comply with bus rules could result in suspension or termination of bus riding privileges.

Required

Student First Name *

Student's first name as listed in enrollment.

Student Last Name *

Student's last name as listed in enrollment.

Student Grade *

Morning Pickup *

Afternoon Dropoff *

Parent/Guardian First & Last Name *

Parent/Guardian Phone Contact # *

Effective Date *

YYYY

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