Bus Pass Replacement Request

District

School

Grade

Student Last Name

Student First Name

Birth Date

GSACRD STUDENT ID#

Please select one of the following

Lost

Broken or Cracked

Stopped Scanning

Replace bus pass cover with loop only

*Please note if your child has lost or damaged their bus pass a $20 fee will be placed on your child’s Powerschool account under "forms and fees" and the new pass will be printed and sent to your child’s school.

*If your child’s pass is no longer scanning we will request to have the pass sent back to the Division Office through your child’s school to be examined. After examination if there is no noticeable damage then the pass will be provided free of charge. If damage is noticed you will receive a phone call and the $20 fee will be assigned to your child’s Powerschool account under "forms and fees".

The information provided on this form, collected under the authority of the Protection of Privacy Act, will be used to provide and support programming and services in Greater St. Albert Catholic Schools. Questions regarding the collection and use of this information can be directed to the Transportation Manager or Access and Privacy Coordinator at 780-459-7711. The information may be used in automated systems to fulfill the purpose stated above

Submitted by I acknowledge that transportation procedures will apply.

Last Name

First Name

Bus Pass Replacement Request

More than one student matches the criteria submitted. Please select the student to use

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