TRANSPORTATION STUDENT RELEASE
2022 / 2023

School Student is Attending:	Grade: Student Name:
Home Address:	Phone:

Parent Guardian:

Daycare / Sitter / Alternate Location: (This location must be within your school boundary)

Name:

Address:	Phone: Effective Date:
Permission is given to transport my child named above to the daycare/babysitter/alternate address listed above for the 2022-2023 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 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 - please sign and date form)	(Date)

Sylvania Schools
ATTN:  Transportation Department
4747 N Holland-Sylvania Road, Sylvania, OH 43560
Telephone: (419) 824-8686 / E-Mail: khamill@sylvaniaschools.org

Revised: 6/1/22