Update Rainbow Route Information

I am requesting to update information for: *

Note: This form is to update a previously submitted application. If you haven't applied for the rainbow Route yet please apply here: Rainbow Route application *

I understand

Child's First Name *

Child's Last Name *

Preschool Employee's Name *

I would like to update: *

Pick Up Address *

Drop Off Address *

The pick-up address is: *

The home address

A daycare provider

The drop off address is: *

The home address

A daycare provider

Daycare provider's name: *

Daycare provider's phone number: *

There are many factors that go into bus placement such as the pickup and drop off address, preschool location, seats available and time of the class. United Way will contact you once we have received your information to let you know if the student will again qualify for bussing based on the new address. The family will be informed by a telephone call about the updated pick up and drop off times if a spot on the Rainbow Route is available. If not, the student will be placed on the waiting list and a telephone call will also inform the family.

New phone number belongs to: *

Mother

Father

Emergency Contact

Daycare provider

What is the updated phone number? *

Name of the person's phone number? *

Is this a work phone number? *

No

Yes

Name of preschool attending: *

Apple Lane *

Community Learning Center ( CLC) & Sumner *

Congo Preschool: *

Head Start *

Pacelli Preschool *

Wee Learning Preschool *

YMCA *

There are many factors that go into bus placement such as pick up and drop off address, preschool location, seats available and time of class. United Way will contact you once we have received your information to let you know if the student will again qualify for bussing based on the new class schedule. The family will be informed by a telephone call about the updated pick up and drop off times if a spot on the Rainbow Route is available. If not, the student will be placed on the waiting list and a telephone call will also inform the family.

Who would you like to replace as Emergency Contact? *

New Emergency Contact Name: *

Emergency Contact Phone Number - Note: This cannot be the same phone number listed for the parents. *

Emergency Contact Relationship to the Child? *

Parent/ Guardian Signature: *

clear

Preschool Employee's Signature *

clear

Email address ( a copy of this form will be emailed to this address):

I understand that these changes will affect my student's current bus situation and there are no guarantees that my child will be placed based on these changes. *

I understand