BUSING REGISTRATION 2020-2021

A fee is charged for all students riding the bus. See back for fee schedule.

There is a walk-in zone that applies to In-Town busing except for Dickinson Middle School

students (Gr. 6-8).

STUDENT INFORMATION

1 Last First

School Grade

2Last First

School Grade

3 Last First

School Grade

4 Last First

School Grade

5Last First

School Grade

BUSING INFORMATION

AM PM Rural In-Town

AM Pick Up Address

PM Drop Off Address

Special Instructions (ex: diabetic, allergies, etc.)

PARENT/LEGAL GUARDIAN INFORMATION

Name

Mailing Address

Day Contact Phone Number

Email Address

Bus rules and regulations handbook available at www.dickinson.k12.nd.us/transportation-information.

I acknowledge that I have been informed about the Dickinson Public Schools bus handbook.

Please allow five (5) business days for students to be added to the bus route or for address changes.

Parent/Legal Guardian Signature: ______________________________________________Date:__________________ See back for fee schedule and mailing address

Please complete this form and return with payment to:

Central Administration Office Attn: Nancy Muffley444 4 St W - Dickinson, ND 58601 701-456-0002 ext 2208

Please pay by cash or check made payable to Dickinson Public Schools

Registration fee is for the entire school year

Students must have a bus badge before riding

IN-TOWN ANNUAL FEE: Must be paid in full before services start.

Full Contract Half Contract – AM or PM Only

One Child -------------------------- $175.00 One Child -------------------------- $90.00 Two Children ---------------------- $195.00 Two Children ---------------------- $100.00 Three Children -------------------- $205.00 Three Children ------------------- $105.00 Four Children --------------------- $215.00 Four Children --------------------- $110.00 Five or More Children ----------- $225.00 Five or More Children ----------- $115.00

RURAL ANNUAL FEE:

Full Contract Half Contract – AM or PM Only

One Child -------------------------- $200.00 One Child -------------------------- $100.00 Two Children ---------------------- $230.00 Two Children ---------------------- $115.00 Three Children -------------------- $265.00 Three Children ------------------- $135.00 Four Children --------------------- $295.00 Four Children --------------------- $150.00 Five or More Children ----------- $325.00 Five or More Children ----------- $165.00

FOR OFFICE USE ONLY

Start Date

FOR OFFICE USE ONLY Student _______

Parent

Status_______________________________

P______ H ______ PP ______ B ______ Q ______

Date Paid

o Check

o Cash

In-Town DMS Rural Beginning Balance

Payment Amount # Date

Balance

Payment Amount # Date

Balance

Payment Amount # Date

Balance

Payment Amount # Date

Balance

P H PP B Q