CCSD NON-PUBLIC SCHOOL TRANSPORTATION REQUEST 2021-2022
Clarence Central School District Transportation Department
9825 County Road
Clarence Center, NY 14032
Phone 716-407-9500
SCHOOL YEAR 2020-2021
DUE BY APRIL 1, 2021
* Required
PLEASE FILL OUT A SEPARATE FORM FOR EACH CHILD
STUDENT'S LAST NAME
*
Your answer
STUDENT'S FIRST NAME
*
Your answer
HOME ADDRESS
*
Your answer
HOME PHONE NUMBER
*
Your answer
START OF SERVICE DATE
*
Date
DATE OF BIRTH
*
Date
GRADE LEVEL
*
Your answer
SCHOOL ATTENDING
*
BUFFALO ACADEMY OF THE SACRED HEART
CANISIUS
CHRIST THE KING
CHRISTIAN CENTRAL ACADEMY
ELMWOOD FRANKLIN
KADIMAH
MT ST MARY'S ACADEMY
NARDIN ACADEMY
NATIVITY OF MARY
NICHOLS
SAINTS PETER AND PAUL SCHOOL
ST AMELIA'S
ST BENEDICT'S
ST CHRISTOPHER'S
ST GREGORY THE GREAT
ST JOHN THE BAPTIST - ALDEN
ST JOSEPH'S COLLEGIATE
ST MARY'S ES - LANCASTER
ST MARY'S HS - LANCASTER
ST MARY'S SWORMSVILLE
THE PARK SCHOOL
WNY MARITIME CHARTER
Other:
SCHOOL ADDRESS
*
Your answer
WHEN DO YOU NEED TRANSPORTATION?
*
At this time, student does not need transportation.
Student will be transported by parent to school.
Student will meet the transfer bus at Harris Hill Elementary at 7:00 AM sharp (if applicable).
Student will ride infrequently but will call 407-9500 on days when home pick up is needed.
Student will only need a ride from school to home
Student will need home pick up and drop off on a regular basis.
FAMILY INFORMATION
FATHER'S NAME
*
Your answer
FATHER'S DAY TIME PHONE NUMBER
*
Your answer
MOTHER'S NAME
*
Your answer
DAY TIME PHONE NUMBER
*
Your answer
EMERGENCY CONTACT PERSON
*
Your answer
EMERGENCY CONTACT PHONE NUMBER
*
Your answer
EMAIL OF PARENT OR GUARDIAN
*
Your answer
COMMENTS
Your answer
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