Ross Local School District
Special Transportation Request Form

*This form is due by July 1st in order to be placed on a route for the first day of school.

Directions: Please fill out and submit a separate form for each child.

Reason for change of transportation request:

Please indicate what date this information is effective:

School your child attends:

Student's Name:

Students Grade:

Name of Parent/Guardian:

Street Address:

Home Phone #:

Work or Cell Phone #:

Emergency Contact:

Emergency Contact Phone #:

AM Pickup Address:

AM Drop-Off Address (For Kindergarten Students):

PM Pickup Address (For Kindergarten Students):

PM Drop-Off Address:

Child care provider's name:

Child care provider's phone #: