SYLVANIA SCHOOL DISTRICT
TRANSPORTATION STUDENT RELEASE
2018 / 2019

School Student is Attending:___________________________________Grade:________

Student Name:____________________________________________________________

Home Address:_______________________________________Phone:______________

Parent/Guardian:__________________________________________________________

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Daycare /Sitter/ Alternate Location Name:
 ________________________________________________________________________

Address:_____________________________________________Phone:_____________

Effective Date:________________________________________

Permission is given to transport my child named above to the daycare/babysitter/alternate address listed above for the 2017-2018 school year.  Please check only one box below.

	BEFORE SCHOOL ONLY

	AFTER SCHOOL ONLY

	BEFORE & AFTER SCHOOL

NOTE:      Only Consecutive Monday–Friday requests within the child’s home  
           Elementary attendance area and to SCS Childcare will be considered.                                 	(Please allow for a three (3) day notice of any transportation change)

Any change to this release will need to be communicated in writing by the parent/guardian to the school and to the Transportation Department as needed.

_______________________________________________________________________
	            (Parent / Guardian)					      (Date)

Sylvania Public Schools
ATTN:  Transportation Dept.
4747 N. Holland-Sylvania Road, Sylvania, OH 43560
Telephone (419) 824-8686 / FAX (419) 824-8789