School Bus Pass Application Form Student Details Firstname: Surname: School: Route: School Year: Please Select.. Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10 Year 11 Year 12 Year 13 Bus Stop: Please Select.. Melbourne - Melbourne Methodist Church, Church Street Wilson - Top of Shorthill Breedon on Hill - Main Street Worthington - Matthews Church Bus Stop, Church Street Newbold - Cloud Hill View Osgathorpe - Storey Arms Main Street Osgathorpe - Dawson Rd/Chapel Ln/Main St Repton - The Cross Bus Stop adj to The School Arch Worthington - Chapel Rise/Main Street Nr Malt Shovel Belton - Market Place Hathern - Derby Road Bus Stop just after The Old Woodyard Loughborough - Loughborough Schools Foundation Long Whatton - Main Street Post Box Opp Smithy Lane Long Whatton - The Green Bus Stop Opp Royal Oak Long Whatton - Bottom of Turvy Lane Mobile Phone: Authorise sending of SMS to Student Tick if disabled access to school transport is required Address Address 1: Address 2: Village: County: Postcode: Parent/Guardian Details Full Name: Relationship: Please Select.. Parent Guardian Phone 1: Phone 2: Email: Payment Scheme: Please Select.. Payment in full (1 x £424.39 Total £424.39) Payment in full ZONE A (1 x £1203.00 Total £1203.00) 3 Payments ZONE A (3 x £406.00 Total £1218.00) 8 Payments ZONE A (8 x £153.50 Total £1228.00) Payment in full ZONE B (1 x £455.98 Total £455.98) 3 Payments ZONE B (3 x £154.33 Total £462.99) 8 Payments ZONE B (8 x £122.00 Total £976.00) Authorise sending of SMS to Parent Photograph of Student Upload a photograph to appear on the pass -head and shoulders - Must be taken in portrait mode. Format required JPG, BMP or PNG. You will need to complete one application form per student * Please ensue the photograph is a high resolution portrait Notes (Add any additional comments here): Part Time Options I Agree to Roberts Travel Group Terms & Conditions (You must agree to these terms in order to proceed) View T&Cs Proceed to payment Part time options × Please select your part time travel options, You will only be allowed to create a travel pass for the current or next term period Select Term Please School Term.. Start Date End Date Day of Week AM Travel PM Travel Monday UNKNOWN DAT101 No Travel UNKNOWN DAT101 No Travel Tuesday UNKNOWN DAT101 No Travel UNKNOWN DAT101 No Travel Wednesday UNKNOWN DAT101 No Travel UNKNOWN DAT101 No Travel Thursday UNKNOWN DAT101 No Travel UNKNOWN DAT101 No Travel Friday UNKNOWN DAT101 No Travel UNKNOWN DAT101 No Travel Alternative Route: Please Select..