Bus Rider Registration Form

Student Name

Student Number

Student's School

Current Grade Level

Student's Primary Address

Will the student require RPS bus service? (select one)

Please complete the information below, making a selection for each day of the week, both AM and PM.

Monday AM

Monday PM

Tuesday AM

Tuesday PM

Wednesday AM

Wednesday PM

Thursday AM

Thursday PM

Friday AM

Friday PM

If secondary address is selected above, please enter the address, Name of adult present at the address, and their relationship to the student.

If daycare was selected above, please list the daycare information here.

My student can be dropped off WITHOUT an adult present at the bus stop. Select yes or no.

If NO, please list adults who may pick the student up from the bus stop.

My child has the following medical condition(s) that may require immediate attention (911) on the school bus:

Additional Comments

Please enter your name, date, and relationship to this student to serve as your digital signature.

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