Transportation for Shared Custody

Caregiver Information

Primary Caregiver

Days Child is in your care

Emergency Contact Information

Secondary Caregiver

Days Child is in your care

Emergency Contact Information

CAREGIVERS MUST ALSO FULLY COMPLETE NEXT SECTION

This form is to be completed by both Parents/Guardians when a shared custody arrangement is in place for the student.

This completed request must be received by the Transportation Supervisor no less than five working days in advance of the requested transportation. The Transportation Supervisor will determine eligibility upon receiving the completed form from the parent/guardian.


In consideration of the agreement of GHSD No. 75 to grant our request as outlined above, I waive the GHSD No. 75, its elected officials and officers, agents, administrators, independent contractors, employees and volunteers from and against all claims, demands, losses, costs, damages, actions and causes of action of any nature whatsoever, including any claim of negligence, arising out of or in relation to any injury or bodily injury including death resulting there from, sustained by my child during any time the said student is traveling on the alternate bus transportation referred to above, and including all travel from his/her/their residence to and/or from the point where he/she/they embark/disembark onto/from the school bus as outlined above.


Courtesy Service is subject to availability and expires at the end of the school year in which it is offered; fees may apply.

Submitted by I acknowledge that transportation procedures will apply.

NOTES: The information on this form is collected pursuant to section 33(c) of the FOIP Act in order to deal with alternate transportation for students and will be used and disclosed only in accordance with the FOIP Act.

If you have any questions about the collection, use or disclosure of information collected on this form, please contact the School Division's FOIP coordinator at 403–934-5121 (ph) or 403-934-5125 (fax).