Bursary Students – Bus Plan Registration

Please note, this form is for Kramer, Sexton or Dilawri Bursary students ONLY. If you are not a Kramer, Sexton or Dilawri Bursary student, please use the Lunch & Bus Registration Form.

Date of Registration *

Student First Name *

Student Last Name *

Parental Email Address *

Confirm Parental Email Address *

Primary Street Address

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Secondary Street Address (If Required)

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Please select the semester(s) in which you require bus service. *Semester 1 (September – January)Semester 2 (February – June)

Bus service required (please check one of the following)Within the city of Regina – both waysWithin the city of Regina – one way service – AMWithin the city of Regina – one way service – PMWhite City – both waysWhite City – one way service – AMWhite City – one way service – PMFor one way service you must choose AM or PM.

Please enter the grade your student will be in when your bus service starts. *

Personal information on this form is collected pursuant to the Personal Information Protection and Electronic Documents Act (“PIPEDA”). Luther College Regina will use your personal information for all administrative and academic matters.

Your information will remain confidential, and will only be used or disclosed for internal purposes and as authorized under PIPEDA. Should you have any questions about the collection of information, please contact Luther College High School at 1.306.757.7399.