THE COMMONWEALTH OF MASSACHUSETTS

Department of Early Education and Care Small Group and Large Group Transportation Plan and Authorization


CHILD'S NAME:___________________________________________________



MY CHILD WILL ARRIVE AT THE PROGRAM:

_____PARENT DROP OFF

_____CONTRACT VAN

_____SUPERVISED WALK

_____PRIVATE TRANS. ARRANGED BY PARENT

_____UNSUPERVISED WALK

_____PUBLIC/PRIVATE/VAN

_____PROGRAM BUS/VAN

_____OTHER


MY CHILD WILL DEPART FROM THE PROGRAM:

_____PARENT PICKUP

_____CONTRACT VAN

_____PROGRAM BUS/VAN

_____PUBLlC/PRIVATE/VAN

_____PRIVATE TRANS.ARRANGED BY PARENT

_____SUPERVISED WALK

_____OTHER


PARENT SIGNATURE___________________________________________________________________

DATE_____________________