Parochial School Transportation Request Byron-Bergen Central School District
Transportation Department
6917 West Bergen Road, Bergen, NY 14416

TRANSPORTATION COORDINATOR

Phone: 585-494-1220 EXT 5112 Email: Transportation@bbschools.org Fax: 585-494-0173

Student: ____________________________________

Student: ____________________________________

Student: ____________________________________

Student: ____________________________________

Student: ____________________________________

DOB: _______________

DOB: _______________

DOB: _______________

DOB: _______________

DOB: _______________

Grade: _____

Grade: _____

Grade: _____

Grade: _____

Grade: _____

Will require transportation to the following parochial school for the school year:

_ Cornerstone Christian

_ Genesee Christian

_ Notre Dame	_ St Paul

_ St Joseph

_ Other (please provide complete address & phone): __________________________________________

____________________________________________________________________________________________

Mother’s Name: ____________________________________________ Work/Day Phone: _________________

Father’s Name: _____________________________________________ Work/Day Phone: _________________

Address: __________________________________________________ Home Phone: ____________________ (Street)	(Apt)

_____________________________________________________ (City)

If your child(ren) require(s) pick-up/drop-off to/from a sitter, please call the Transportation Department (585-494-1220) and request a childcare form; sitters must reside in the B-B district.

In the event of an emergency, please provide us with an alternative drop off point for your child(ren) within the Byron-Bergen School District; please include the name, address and phone of this family. Thank you.

________________________________________________________________________________________________

________________________________________________________________________________________________

Please provide us with any medical conditions or special problems that the driver should be aware of: _____________________________________________________________________________________________

________________________________________________________________________________________________

Parent/Guardian Signature: ________________________________________	Today Date: __________________

Whenever Byron-Bergen Central School District is not in session either because of weather conditions or scheduled recess, there will be no bus transportation provided to private or parochial school services by Byron-Bergen Central School. No transportation is provided in the afternoon for scheduled half (1/2) days by Byron-Bergen Central or parochial school.

Section 3635 of the Education Law states that requests for transportation to nonpublic schools must be submitted to the home district prior to April 1st, and that a timely filing of the request is the responsibility of the parent/guardian; reliance on the nonpublic school will not serve as a reasonable excuse for lateness.

To submit form by email, save it and send as an attachment to Transportation@bbschools.org.