- Compass Public Charter School

Busing is provided by Durham School Services

www.durhamschoolservices.com

One Form Per Student

Is this form for:

School Year 2025-2026

Does your student need busing?

Yes
No

Is your student:

New Compass Student
Returning Student
Add to 2nd Bus

Student Name

First

Last

Student Grade

Male / Female

Female
Male

Student Birth Date

Parent/Guardian Info

Parent/Guardian #1 Name

First

Last

Parent/Guardian #1 Cell Number

Parent/Guardian #1 Work/Other Number

Parent/Guardian #1 Email

Parent/Guardian #2 Name

First

Last

Parent/Guardian #2 Cell Number

Parent/Guardian #2 Work/Other Number

Parent/Guardian #2 Email

Student Home Address

Not a PO Box

Student Home Street Address

Must be a street address, not a PO Box

City

Zip Code

Nearest Crossroads

Example: Blackcat & Franklin

Does Your Student Need Busing In The Morning, Afternoon or Both?

AM Only - to school
PM Only - after school
Both AM & PM

Is the morning pickup address different than the home address listed above?

Yes
No - The address above is the address the student will get on the bus

(Does student get on the bus from daycare, babysitter, etc)

Is the afternoon dropoff address different than the home address listed above?

Yes - The student gets dropped off elsewhere (babysitter, daycare, etc)
No - The address above is the address the student will use to get off the bus

AM (Morning Pickup)

AM Pickup Street Address (if different from home address):

(eg: Babysitter, daycare, YMCA, grandparent)

Nearest AM Pickup Crossroads:

eg: Blackcat & Franklin

PM (Afternoon Dropoff)

PM Dropoff Street Address (if different from home address):

(eg: Babysitter, daycare, YMCA, grandparent)

Dropoff City

Dropoff Zip:

Nearest PM Dropoff Crossroads:

Example: Blackcat & Franklin

Emergency Contacts

Other than parent/guardian listed above.

Emergency Contact #1 Name:

First and Last Name

Emergency Contact #1 Phone Number

Emergency Contact #1 Relationship to Student

(eg: Grandma, babysitter, sibling, uncle, etc)

Emergency Contact #2 Name:

First and Last Name

Emergency Contact #2 Phone Number

Emergency Contact #2 Relationship to Student

(eg: Grandma, babysitter, sibling, uncle, etc)

Who is authorized to meet the kindergarten student at the bus stop?

If kindergarten students do not have anyone to receive them at their bus stop after school, they will be returned to the school to wait for an adult to come and get them.

Is kindergarten student approved to get off the bus with sibling(s) even if an authorized person is not present?

Yes
No

Sibling Name

First

Last

Authorized Pickup Person #1 Name (if different than the above emergency contacts)

First

Last

If different than the above Emergency Contacts

Authorized Pickup Person #1 Relationship to Student

(eg: sibling, grandma, babysitter, sibling, uncle, et)

Authorized Pickup Person #2 Name (if different than the above emergency contacts)

First

Last

Authorized Pickup Person #2 Relationship to Student

(eg: sibling, grandma, babysitter, sibling, uncle, et)

Authorized Pickup Person #3 Name (if different than the above emergency contacts)

First

Last

Authorized Pickup Person #3 Relationship to Student

(eg: sibling, grandma, babysitter, sibling, uncle, et)

Authorized Pickup Person #4 Name (if different than the above emergency contacts)

First

Last

Authorized Pickup Person #4 Relationship to Student

(eg: sibling, grandma, babysitter, sibling, uncle, et)

Kinder Drop-Off Agreement

I understand that if an authorized pickup person is not at the bus stop at the end of the day to receive my kindergarten student, they will be brought back to the school to wait for an adult to pick them up.

Agreements & Signature

Permission

I am giving permission for my student to be placed on a bus roster with Durham School Services.

Missed Stop Agreement

I understand that if my student misses their stop at the end of the day, they will be brought back to the school and wait with a bus driver for an adult to pick them up.

Parent/Guardian Signature

Please type the name of the person filling this form out.

Date