Form must be completed in one sitting.

HLA buses run from Independence Ave. to 63rd Street and from Troost to Van Brunt

Student's First Name

Student's Last Name

I understand that transportation for my child is a courtesy that can be revoked for the above reasons:

Does your student need bus transportation?

Yes

Home Address

Morning Pickup

Same as home

Other

Morning Address

Afternoon Drop-off

Same as home

Other

Afternoon Address

Parent/Guardian Name

Parent/Guardian Phone

Signature

Date