Of your check write Bus Fee . Forward the check and this ...

Columbus School for Girls 2018-19 Student Transportation Registration Form

I wish to contract transportation for my child in accordance with Columbus School for Girls Transportation Department for the school year, August, 2018 through June, 2019. The fee for transportation is $900.00 per student round trip, $500.00 per student one way.

Please make your check payable to Columbus School for Girls and in the memo portion of your check write Bus Fee . Forward the check and this completed form to Columbus School for Girls, Business Office, Department L-2018, Columbus, OH 43260-2018.

Enclosed is Check No.___________ in the amount of $_______________.

Student Name: ________________________________Grade: _________ Student Name: ________________________________Grade: _________ Student Name: ________________________________Grade: _________

New Albany/East Side Route - check pick-up point

_____ Kroger at 5161 Hampsted Village Center Way _____ Kroger at 7000 E. Broad Street

New Albany/East Side Route - check drop-off point

_____ Kroger at 5161 Hampsted Village Center Way _____ Kroger at 7000 E. Broad Street

Dublin Route - check pick-up point

_____ Panera Bread at 8835 Owenfield, Powell _____ Kroger at 299 Bridge Street, Dublin

Dublin Route - check drop-off point

_____ Panera Bread at 8835 Owenfield, Powell _____ Kroger at 299 Bridge Street, Dublin

Parent/Legal Guardian (please print):

_____________________________________

Signature:____________________________________________________

Home Address: __________________________________________________

Phone Number and Cell Number: ____________________________________

Email address:_________________________________________________ Emergency Treatment Authorization I give Columbus School for Girls permission at any time to allow faculty or staff members or other persons authorized by the School to authorized emergency medical care for the student (s) named above.

Parent/Guardian Signature

Date

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download