ST MARY’S COLLEGE 6TH FORM 2013-14

APPLICATION FORM FOR A 6TH FORM STUDENT BUS PASS FOR THE ELLIE ROSE SCHOOL DIRECT BUS SERVICES

940, 955, 956, 957, 958, 959, 960 and 961.

This form is to be used to apply for a 6th form student bus pass and the following rules apply:

  • The bus pass will cost £5 a week and will only be issued on a half termly basis
  • Payment must be made in advance via PARENT PAY for the following half term. Cash/cheques will not be accepted.
  • The completed application should then be returned to the 6th form office.
  • The 6th form admin staff will issuethe bus pass to the student when it is received from Hull City Council.
  • Hull City Council will provide the bus pass and you must show the bus pass to the driver in order to be allowed on the bus.
  • If you do not have your bus pass with you, you will need to pay the current daily bus fare direct to the driver.
  • If you choose not to pay to renew your bus pass you must hand it back to the 6th form admin officer no later than the first day of the half term for which you have not paid. It would be a fraudulent offence to use your bus pass if you have not paid the due amount.
  • The bus pass can only be used on the school direct bus services operated by Ellie Rose and cannot be used on any other bus service or outside of school term time.

APPLICATION

Student name ______

Address______

______

______

Which bus will the student use? ……………………………..

Please refer to the Payment Schedule on the reverse page and complete:

First Payment on Parent Pay of £ …………………..

To cover the half term commencing ______.

I agree to follow the above rules and return the bus pass if I choose not to continue to pay for the half termly bus pass by the due date.

Student signature ______

Schedule of Payment and payment dates for the half termly bus pass

Half TermCostPass from Payment due byWeeks covered

Autumn 2£355th November 19th October 7

Spring 1£257th January14th December5

Spring 2£2518th February1st February5

Summer 1£358th April 15th March7

Summer 2£303rd June17th May6

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OFFICE USE: The bus pass will only be issued when Finance have confirmed that full payment has been received on Parent Pay.

Student Eligible

Amount Paid

Checked payment received on Parent Pay Date/Staff Name

Bus pass issued/renewed
Date

Amount Paid

Record payment on Spreadsheet

DateSignature