Transportation Request

Opt-In

I have read and agree to the Transportation Policies and Procedures.

Child's First Name

Child's Last Name

Parent's First Name

Parent's Last Name

Home: Street Address

City

State / Province

ZIP / Postal Code

Parent Contact Phone Number

Email

Emergency Contact Name

Emergency Contact Phone

School/Activity Name

School/Activity: Street Address

School/Activity: City

School/Activity: State / Province

Location ZIP / Postal Code

School/Activity Start Date (mm/dd)

School/Activity End Date (mm/dd)

Does rider request use of the lift? (Typically for riders with a wheelchair or walker)

Yes

No

Before School/Activity Pick-up Time

Pick-up Address

Pick-Up Phone

Pick Up Day (mark all that apply)

After School/Activity Pick-up Time

Delivery Address

Drop-off Phone

Drop Off Day (mark all that apply)

Free Text

NOTE: All cancelations and changes MUST come through the dispatch office. Do not call your driver. If you need to cancel a ride for whatever reason and you do not notify dispatch before the start of the route, YOU WILL BE CHARGED FOR THAT RIDE.

Dispatch Center: 507-634-4340 option #1 Email: rhtbus@semcac.org Fax:507-634-4339

Transportation Request

Please Read Transportation Policies and Procedures

Transportation Request

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