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
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