2022-2023 Emergency Contact Form K-12
Name:__________________________ Birth Date:___________ Sex: M____ F____ Pick-Up Address:_______________________ Drop-Off Address:______________________ Special Needs (Medical or Other):_____________________________________________ Name of School or Day Care:_________________________________________________ School Start/End Time:________/________ Ride Start/End Date:________/_________ Ride Needed: Before School___ After School___ Days M__T__W__Th__F__ As Needed__ Consent for child’s photo to be use on NPPT’s Facebook Page and/or other media Y__N__ Mom’s Name:_________________________ Dad’s Name: :_________________________ Mom’s Employer:______________________ Dad’s Employer:_______________________ Home Phone:_________________________ Home Phone:_________________________ Work Phone:__________________________ Work Phone:__________________________ Cell Phone: ___________________________ Cell Phone:___________________________ Email:________________________________ Email:______________________________ Child’s Address: ____________________________________________________________ Emergency Contact:_____________________ Phone:______________________________ Daycare Contact:_______________________ Phone:______________________________ · If your child does not have proper bus fare, they will not be able to ride the bus · North Platte Public Transit will cancel transportation after 3 consecutive “NO SHOWS” · 24 hour advance notice to set up rides · Bullying and uncooperative behavior will result in removal of your child from the schedule
I have read, understand, and agree to all terms and conditions. Signature & Date:__________________________________________________
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Advance Reservations are requested to allow for your student to get their needed pickup time!
Youth Transportation No child will be transported unless an Emergency Contact Form is on file at NPPT. This applies to all children riding the bus, regardless of the number of times a child will be riding. This form is for your child’s safety. No rides can be charged. If your child does not have correct change (our drivers do not carry change), they will not be able to ride the bus. E Passes can be purchased over the phone with a debit card, by calling the transit office or by paying the driver with cash or check. It is your responsibility to contact us regarding changes in your child’s schedule. For safety reasons, we cannot take information regarding transportation changes from your child or daycare. During morning pickup, it’s a tight schedule and the longest we will wait for the student is 3 minutes. They need to be watching out the window for us starting at 7am. We might not be there right at 7am but they need to be watching and looking. Buses will arrive at the schools at dismissal time and depart approximately seven minutes later. Rides required after the bus departs will cost an additional fare. Routes are determined by first come first serve and according to school times.
Seatbelts are required to be worn by all passengers, please make your child aware of this and that they need to get to their seat quickly and put their seatbelt on.
NO Bullying Allowed Poor conduct, including bullying and foul language, will not be tolerated and could result in being banned from riding the bus. A child’s bus ride should be a positive experience and negative behaviors jeopardize everyone’s safety.
308-532-1370 Dispatcher/Reservations 1520 North Jeffers St
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