Springbrook Bus Pass Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

One application is needed for EACH student that attends Springbrook in 2019-2020.

Excerpts from Regulations governing Pupil Transportation:
1. Pupils must display Springbrook's Respectful, Responsible, & Ready behavior at all times and obey the instructions of the driver.
2. Bus Pass must be shown when requested.
3. Rides may be refused if Bus Pass is not presented.
4. Transfer of this Bus Pass automatically revokes all rights to its use.
5. All students transported in a school bus are under the direct authority of the driver and must follow all school rules.

Violation of Rules of Conduct will result in denial of transportation as follows:
1st offense..........warning / suspension
2nd offense.........3 days bus denial
3rd offense..........5 days bus denial
4th offense..........Determined by administrator / transportation
Extreme Acts of Violence....... Immediate bus denial

Email *

Student's Legal First Name *

Student's Legal Last Name *

Student ID number, you can find it on the Parent Portal

Grade for NEXT school year, 2019-20 *

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Current Teacher *

Address *

City *

Zip Code *

Bus Stop *

Springbrook School

Wintermist Park

Springbrook School AM/Boys & Girls Club After School Program (Enrolled, After School Only)

Wintermist Park AM/Boys & Girls Club After School Program (Enrolled, After School Only)

Parent drop-off AM/Boys & Girls Club After School Program (Enrolled, After School Only)

Busing Options *

One Way AM

One Way PM

Both Ways

Other:

Student Release Option *

TK and Kindergarten - 3rd Grade Student MUST BE Met at the school bus by a parent or designated adult.

1st - 3rd Grade Student MAY BE RELEASED from the school bus without a parent or designated adult (ALL TK and Kinder students must be met). Fill out the Primary Grade Release Form if selecting this option: https://goo.gl/tj8G8a. Office must have this on file.

Student is in Grades 4-6 and will be released without a parent or designated adult.

Home Phone *

Mother's Name *

Mother's Cell Phone *

Mother's Work Phone *

Mother's Email *

Father's Name *

Father's Cell Phone *

Father's Work Phone *

Email *

Emergency Name of person to contact *

Emergency Phone Number of person to contact *

Relationship to Student of Emergency Person *

Emergency Name of person to contact *

Emergency Phone Number of person to contact *

Relationship to Student of Emergency Person *

Emergency Name of person to contact

Emergency Phone Number of person to contact

Relationship to Student of Emergency Person

I certify that I have received the School Bus Service Guidelines. I certify that the above information is correct and may be verified. Please type your name below in acknowledgement. *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Irvine Unified School District. Report Abuse

Forms