Daily Bus Service Registration Form
Part 1: Cluster Stop Choice Selection

Check off the primary stop your child(ren) will be using so we may determine ridership needs. Afternoon buses will leave Clayton Gym at 4:15pm and 6pm.

Primary Stop Cluster Stops (approximate locations) Morning pick-up time
St. Theresa's Catholic Church (Small Dr. & Cross Valley Run) 6:50 AM
Balcones Dr. & Perry Lane 7:00 AM
Tarrytown: Exposition Blvd.@Bowman Ave. 7:10 AM
Bee Caves & Walsh Tarlton (near Jason’s Deli) 7:20 AM
Because daily traffic can vary, please arrive five minutes before your scheduled departure time in case the bus is running ahead of schedule, and allow five minutes after your scheduled departure time in case the bus is caught in traffic and running late getting to your scheduled stop.
Part 2: Rider & Fee Calculation
Student Student Name Grade Level Type of Rider
Rider #1
Rider #2 (Sibling)
Rider #3 (Sibling)

Fee Schedule:

Two-way bus rider $1700.00
Morning bus rider $ 850.00
Afternoon bus rider $ 850.00
Sibling two-way bus rider(s) $1550.00

Sibling morning bus rider(s) 		$ 775.00
Sibling afternoon bus rider(s) $ 775.00
   

Deadline to Register & Pay: This registration form and the non-refundable fee of $1700.00 for two-way daily bus service and $850.00 for one-way service are due by August 15, 2011. Late registration and payment will be accepted on a space available basis.

Payment may be made here online with registration by credit card

Payment via credit card must be made with registration  
 

If there are late additions to the bus ridership or other factors that lower the cost, there may be a refund due to you at the end of the year. Similarly, if gas prices rise above anticipated levels, there is the possibility of each family needing to pay up to $50/child/way. For additional information, please contact bus@sstx.org

 
Part 3: Contact Information
Parent/Guardian Name:
Phone:
Email:
Address:
   
Parent/Guardian Name:
Phone:
Email:
Address:
   
Emergency Contact Name:
Phone:
   

Part 4: Peterman School Services Information & Release
I/We agree that the above information may be provided to Peterman School Services for emergency and contact purposes only. Check to Agree
Name:
Date:
   
Part 5: Bus Rules & Agreements

1.Stay in your seat.
2.Keep head, hands and feet inside bus.
3.Do not tamper with bus equipment.
4.Do not use profane language on bus.
5. Keep the bus clean.
6. No horse play or fighting on bus
7. Students must be on time to bus.
8. Be courteous to driver.
9. Observe classroom conduct on bus.

Parent/Guardian/AdultRider Rules Agreement:  
As the adult rider or parent/guardian of a bus rider, I have read the bus rules and agree to follow or help my child follow them to the best of my ability and abide by the consequences of any infractions of the rules. I also understand that this cooperative bus service is subject to changes and limitations based on the level of participation. Check to Agree
Name:
Date:
   
Student Rules Agreement:  
I have read the bus rules and agree to follow them and abide by the consequences of any infractions of the rules.  
Student 1 Agreement
Student 2 Agreement
Student 3 Agreement