To: Board of Education or Board of Trustees

I am requesting transportation for my children to and from Covenant Love Community School, 1768 Dryden Road, Freeville, NY 13068, Phone - 347-4413.

Transportation needed:  A.M. Only ____  P.M. Only ____  Both ____

Other (explain) _________________________________________________

Student Information:

Home Address: ______________________________________________________________

Home Telephone: _________________________

Parent Name: _____________________________  Work Phone: _________________

Parent Name: _____________________________  Work Phone: _________________

Emergency Name: _____________________________  Phone: _________________

Day Care Information: (if children are to be transported there after school):

Name: _____________________________  Phone: _________________

Address: _______________________________________________________________

Note: Please return this form to CLCS, not to your local school district. Thank you.