Parkland Transport


Student Information


Surname (last name): *

Given name: *

Nickname (AKA)

Date of birth: *

Grade: *

Gender: *

School: *

French Immersion: *


Parent/Guardian Information


Full names: *

Home phone: *

Work phone:

Email Address *


Address


Mailing address, City, Postal Code: *


Location


Legal description:

Subdivision:

Lot:

Block

If you don't have a municipal address, indicate which RR/TWP Road your driveway meets:


Other


Wheelchair student: *

Effective date:

Additional information:


Previous Bus (if any)


A.M. (Route # only):

P.M. (Route # only):


Medical Information


Any special procedures required? (ie. seizure requiring the use of the epipen)