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Centralia Student Transportation Form

This form must be completed in full for transportation to be provided.

Student Information:

Student Name*

Answer Required

Today's Date

Answer Required

School*

Answer Required

Grade*

Answer Required

Gender*

Answer Required

Home Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Mailing Address (if different from above)

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Parent/Guardian Information:

Parent/Guardian Name

Answer Required

Home Phone

Number Required

Work Phone

Number Required

Cell Phone

Number Required

Other Phone

Number Required

Emergency Contact:

Emergency Contact

Answer Required

Emergency Phone

Number Required

Pick up/Drop off Location Selections:

Pick Up Location- Mark Selection(s) below*

Answer Required

No Transportation Needed

Pick up at home address listed above

Pick up at other location listed below

Drop Off Location- Mark Selection(s) below*

Answer Required

No Transportation needed

Drop off at home listed above

Drop off at other location listed below

*PLEASE NOTE: For Elementary Students Only

Transportation can only be provided to/from locations within your elementary school boundary

Alternate Pick up location:

Pick up location

Answer Required

Contact person

Answer Required

Phone

Answer Required

Address

Answer Required

Alternate drop off location:

Drop off location

Answer Required

Contact person

Answer Required

phone

Answer Required

Address

Answer Required

To provide your child with school transportation, it is necessary to have accurate and current information. if CHANGES occur with any of the above inforamtion (i.e., student moves, changes in childcare), please contact your student's school and our Transportation Team immediately at 360-330-7628.

Confirmation Email

Email Required