Does your child require our bus service? YES ( ) NO ( )

Student's name: ____________________________________________________ grade ____________________

Parents' names _______________________________________________________________________________

Home telephone # ________________________________ Business ___________________________________

Starting date: ________________________________________________________________________________

Please print exact home address: ________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Other necessary information _____________________________________________________________________

____________________________________________________________________________________________

Country Day School makes every effort to provide bus service to all of its students. However, because we serve

Tamarindo, Langosta, Flamingo, Potrero and Playa Grande, students cannot be offered door-to-door service.

I understand the above and agree to instruct my child on the proper behavior for riding on a school bus. I also

understand that disruptive behavior may result in loss of bus privileges.

____________________________________________ ____________________________________________

Parent Date Student Date

Country Day School