1.	Child's Last Name*

2.	Child's First Name*

3.	Child's Street Address*

4.	City, State, Zip*

5.	Parent/Guardian Name*

6.	Contact Phone Number*

7.	Child's Date of Birth*
	mm/dd/yyyy

8.	Email Address

9.	Names of brothers and/or sisters

10.	Do you need bus transportation in the morning?*
	No in the morning    Yes in the morning from home    Yes in the morning from alternate stop    Please specify the alternate stop requested.

11.	Do you need bus transportation in the afternoon?*
	No in the afternoon    Yes in the afternoon to home    Yes in the afternoon to alternate stop    Please specify the alternate stop requested.

12.	If transferring from another school, name of current school.