Indicate the way your child will usually arrive and depart from school. Please read all of the options before checking ONE in the arrival column and ONE in the dismissal column.
Arrival
Dismissal
OPTION 1 - Walking (alone or with other children)
OPTION 2 - Walking (with adult supervision) - If you select this option, please list the names of the adult(s) below that have permission to walk with your child.
OPTION 3 - School Bus (per notification from the school district)
OPTION 4 - Kirby Bus (for students enrolled in the Kirby Program)
OPTION 5 - Car Transportation - If you select this option, please list the names of the adult(s) below that have permission to drive your child.
OPTION 6 - Child is enrolled in Before/After Care Program
OPTION 7 - Child will meet/pick-up sibling after school - If you select this option please indicate sibling's name below and pick-up location.
OPTION 8 - Parent or designee will pick/drop their child at the following location - If you select this option please indicate the parent/designee by name and identify the pick-up/drop-off location.
Arrival
Dismissal
OPTION 1 - Walking (alone or with other children)
OPTION 2 - Walking (with adult supervision) - If you select this option, please list the names of the adult(s) below that have permission to walk with your child.
OPTION 3 - School Bus (per notification from the school district)
OPTION 4 - Kirby Bus (for students enrolled in the Kirby Program)
OPTION 5 - Car Transportation - If you select this option, please list the names of the adult(s) below that have permission to drive your child.
OPTION 6 - Child is enrolled in Before/After Care Program
OPTION 7 - Child will meet/pick-up sibling after school - If you select this option please indicate sibling's name below and pick-up location.
OPTION 8 - Parent or designee will pick/drop their child at the following location - If you select this option please indicate the parent/designee by name and identify the pick-up/drop-off location.
OPTION 2 - FOLLOW UP: The following adult(s) have permission to walk with my child.
Your answer
OPTION 5 - FOLLOW UP: The following adult(s) have permission to drive my child.
Your answer
OPTION 7 - FOLLOW UP: The following sibling(s) have permission to meet/pick-up my child. (Indicate name of sibling and pick-up location.)
Your answer
OPTION 8 - FOLLOW UP: The following parent/designee has permission to pick-up/drop-off my child. (Indicate name of parent/designee and pick-up/drop-off location.)
Your answer
Parent/Guardian E-Signature *
Your answer
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