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Glenbard Township High School District 87
Policy 4:110-E2

Operational Services


Exhibit – FEE-BASED BUSING APPLICATION FORM

Date Submitted: ___________________

School: ________________________________________________  School Year: ______________________

Student Name: ______________________________ ID #: _________________    Grade: ________________

Student Name: ______________________________ ID #: _________________    Grade: ________________

Student Name: ______________________________ ID #: _________________    Grade: ________________

Address: _________________________________________________________________________________
                Street                                                                                                  City                                                            Zip

Parent/Guardian Name: ________________________________________ Phone #: _____________________

Existing Bus Route: _________________________________________________________________________

Existing Bus Stop: __________________________________________________________________________

By signing below and submitting this request, I agree to participate in the Glenbard District 87 fee-based busing program and
agree to pay the annual fee set yearly by the Board of Education.  I understand that this program is based on space available
as set by Board Policy 4:110-R1 and that my child(ren)'s eligibility can be revoked if the number of bus riders eligible for free
service reaches capacity.  Should this occur, my fees will be refunded on a prorated basis.  I further understand that my
child(ren) must receive the bus at an already and regularly established bus stop.  I also agee that my child(ren) will abide by
all of the bus rules and regulations and that my child(ren)'s privileges to ride the bus may be revoked for inappropriate behavior
or infractions of the rules, as determined solely in the School District's discretion.  There will be no refund of fees if privileges
are revoked for disciplinary reasons.

Finally, I accept full responsibility for my child(ren)'s safety when determining which bus stop is the most appropriate.

__________________________________________________________   ___________________________
Parent/Guardian Signature                                                                                             Date


_________________________________________________________________________________________

For District Office Use Only

Approved:  Yes  ______    No ______

__________________________________________________________   ___________________________
Director of Transportation                                                                                        Date


Fee:  $ _________________   Date Paid: _________________


DATED:        September 28, 2009

REVIEWED:  February 7, 2011

REVISED:     February 22, 2011