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Medina Central School District Transportation Request
This information is critical for planning purposes. This form MUST be completed for EACH student by a parent/guardian.
*** Transportation Requests Can Take Up to 30 Days to Take Effect as per School Policy #5721 ***
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Student's gender
*
Male
Female
Required
Birth Date
*
MM
/
DD
/
YYYY
Building and Grade Level
*
Choose
Pre-K - Oak Orchard Primary School
Kindergarten - Oak Orchard Primary School
Grade 1 - Oak Orchard Primary School
Grade 2 - Oak Orchard Primary School
Grade 3 - Wise Intermediate School
Grade 4 - Wise Intermediate School
Grade 5 - Wise Intermediate School
Grade 6 - Wise Intermediate School
Grade 7 - Medina Junior/Senior High School
Grade 8 - Medina Junior/Senior High School
Grade 9 - Medina Junior/Senior High School
Grade 10 - Medina Junior/Senior High School
Grade 11 - Medina Junior/Senior High School
Grade 12 - Medina Junior/Senior High School
Student's Home Address
*
Your answer
Babysitter/Day Care Address
Your answer
Parent/Guardian Full Name
*
Your answer
Parent/Guardian's Phone Number
*
Your answer
Parent/Guardian E-mail
Your answer
How will your child get TO SCHOOL? (Where will transportation pick them up?)
*
Home
Babysitter/Day Care
No transportation needed (drop off, walk)
Monday
Tuesday
Wednesday
Thursday
Friday
Home
Babysitter/Day Care
No transportation needed (drop off, walk)
Monday
Tuesday
Wednesday
Thursday
Friday
How will your child LEAVE school? (How will they get home?)
*
Bus to Home
Bus to Day Care/Babysitter
Walker - must live in walk zone
Pick Up - per building procedures
Monday
Tuesday
Wednesday
Thursday
Friday
Bus to Home
Bus to Day Care/Babysitter
Walker - must live in walk zone
Pick Up - per building procedures
Monday
Tuesday
Wednesday
Thursday
Friday
When would you like this transportation to start?
*
MM
/
DD
/
YYYY
By typing my name below, I certify that I am the parent/guardian of this student and authorize transportation as indicated above.
*
Your answer
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