Alternate Transportation

970 Route 146, Clifton Park, NY

Phone 518-881-0240 Fax 518-371-3126

The Shenendehowa Central School District provides transportation services to daycare providers according to Board of Education Policy. Please complete this form if you request transportation to a daycare provider which is located at an address other than the student’s designated home address.

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The following student(s) will be going to a child care location for the 20__-20__ school year.
Student(s) Name			School					Grade
Student’s Home Address					Child Care Provider’s Address
Students Home Phone				Child Care Provider’s Phone
Child Care Provider’s Name
* Elementary students must be picked up at same address 5 days a week. Likewise in PM, must be dropped off at same address 5 days a week.
A.M. Pick-up Location		Noon Pick-up/Drop-off Location					P.M. Drop-off Location
Parent(s) Name
Parent(s) Business Phone:	Father_____________					Mother_______________
Effective Date ____________________ Parent Signature ________________________
Date Signed ________________________
Return Completed form to: Shenendehowa Central School District – Transportation Dept 970 Route 146 Clifton Park, NY 12065