LSBP Annual Bus Pass - Orinda - 2017-2018
Orinda Registration Form
Please review your student's school bus schedule before registering as there have been changes.
complete and submit one form per student. Proceed to check out
after the last student. * Items are required
Student First Name
Student Last Name
Grade Fall 2017-18
Did this student ride the bus last year?
Updgrade to Round Trip
Please enter as listed on Bus Schedule
(e.g. Condit @ Windsor)
Alternate Bus Stop
Most students do not need an alternate bus stop. Fill out only if your student uses two different stops on the same route.
Parent 1 Full Name
Parent 2 Full Name
First & Last Name
Enter as 000-000-0000. With a cell number you're eligible for TEXT messaging re: late buses.
Please authorize up to three persons (other than parents) to accept your student in case of emergency.
K and 1st grade students must be met by a parent or other authorized person.
DISABILITY OR MEDICAL CONDITION
Does this student have a disability or medical condition? If yes, please explain
COMMENTS AND SIGNATURE
Comments or Special Requests
My initials indicate my child has permission to ride the bus and use the bus stops listed and that my child will follow the
Failure to follow the rules may result in suspension or expulsion. I authorize the use of my cell number to receive TEXT messages re: late buses. I understand I may opt out of this service at any time. I accept all responsibility for the transportation of my child to and from the bus stops. I understand and agree that the Lamorinda School Bus Transportation Agency (LSBTA) does not provide supervision while waiting at the bus stop. I hereby release on behalf of myself and my child and agree to hold the LSBTA harmless from any liability or responsibility for injuries or damage arising out of or related to the use of the bus service.
N0 (go to check out)