West Sonoma County Union High School District

2018-2019 School Year

SCHOOL TRANSPORTATION Free & Reduced Bus PASS APPLICATION

This annual registration form is for a school district that does not charge fees for school transportation. In compliance with Agency Policy and State Law, students who ride school buses must register for transportation service, be assigned to a bus stop, receive a pass, and display the pass for every boarding. Bus passes are non-TRANSFERABLE and forgery or duplicate use of a bus pass will result in expulsion from the school bus. Passes need to be presented to the driver upon boarding the bus for each ride. If pass is damaged or lost, first replacement will be free. Any replacement thereafter will incur a $5.00 charge

1st Student Name *
1st Student Name
Date of birth *
Date of birth
Foster Child / Homeless *
Check the applicable box
2nd Student Name
2nd Student Name
Date of birth
Date of birth
Foster Child / Homeless
Check the applicable box
3rd Student Name
3rd Student Name
Date of birth
Date of birth
Foster Child / Homeless
Check the applicable box
4th Student Name
4th Student Name
Date of birth
Date of birth
Foster Child / Homeless
Check the applicable box
Home Mailing Address *
Home Mailing Address
Phone *
Phone
Do ANY household members (including yourself) currently participate in one of the following assistance programs? *
Parent/ Guardian *
Parent/ Guardian
$
OTHER HOUSEHOLD MEMBER (all household members must be listed)
OTHER HOUSEHOLD MEMBER (all household members must be listed)
$
OTHER HOUSEHOLD MEMBER (all household members must be listed)
OTHER HOUSEHOLD MEMBER (all household members must be listed)
$
OTHER HOUSEHOLD MEMBER (all household members must be listed)
OTHER HOUSEHOLD MEMBER (all household members must be listed)
$