Bus Signup Form
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Family Name
Last Name
 
Student 1 Bus Signup  
Student 1 Name
First Name Middle Name Last Name
My child will ride the bus:
Select Trip
Select Time
My child needs to be picked up/dropped off at the following locations.
MORNING PICK-UP: 7:30 a.m. – Saint Francis Church – Please be on time. Arrive at school about 8:00 a.m. School classes begin at 8:15am.
AFTERNOON DROP OFF:
I agree to make the bus payments to Saint Francis Xavier. If bus payment are delinquent by 30 days or not paid in full by June 1, the child/children will not be able to continue the use of bus transportation.
I/We will pay in full by September 1.
I/We agree to Automatic Debit of our payment from Sept. 1-May 1. Please fill out automatic debit form.
Parent Signature *
Do you agree? * Name * Date (MM/DD/YYYY) *
Section I
Preferred Contact Method
Family resides in which Public School District
(Specify: Murphysboro, Carbondale Dist. 95, Giant City, Unity Point, Trico, Carterville, Cobden, etc.)

Will child(ren) ride the Murphysboro District 186 bus?
If yes: Bus #
Will child(ren) use Saint Francis Xavier transportation?
If Yes

(There is a cost of $60 per month for the Saint Francis, Carbondale Bus.)

Will child(ren) attend the Extended Care Program?
Days & Approx. Pickup Time:
Does the child live more than a mile and a half from Saint Andrew School?
* Younger sibling(s) who will attend SAS in 2018/2019
Name
First Name Middle Name Last Name
Grade
Date of Birth
- -
MM DD YYYY
Name
First Name Middle Name Last Name
Grade
Date of Birth
- -
MM DD YYYY
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723 Mulberry Street, Murphysboro, IL 62966
Phone: 618-687-2013
Fax: 618-684-4969
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