Daycare Request Form
(or Alternative Pick-up/Drop-off Location)

Important: Use this form only if your child is using daycare and needs to ride the bus between the daycare location and school.

Please also use this form if your child is attending Wayzata Kids.

District 284 Transportation Policy allows transportation services to and from a daycare site under the following guidelines:

1. The daycare location must be within the attendance are of your child's school.
2. The child must always be picked up or dropped off at the same daycare location.
3. Arrangements for busing must be made in writing through the Transportation Department.
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Student Information
Student's First Name *
Student's Last Name *
School *
Grade *
Head of Household
Last Name *
First Name *
Middle Name
Home Address & Phone Number
Street Address *
Apt. #
City *
Zip *
Phone *
E-mail Address *
Name of Daycare Provider (Person or Company)
Last Name *
First Name *
Middle Name
Daycare Provider Address and Phone #
Address *
Apt. #
City *
Zip *
Phone *
Daycare Transportation Needs *
Beginning Date *
Ending Date *
I realize it is my responsibility to bring my child to and from this daycare site.  I do hereby agree to save the School District harmless for any damage resulting from its granting this request. *
Required
Signed *
Type name of acknowledging legal parent / guardian.
Date *
Submit
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