press release - Marlborough Public Schools

Marlborough Public Schools
Daycare Affidavit for Transportation Services
Instructions: Any student in a daycare setting who receives transportation services to/from one of the Marlborough Public
Schools must file this completed affidavit to receive those busing services from the daycare location. Please file this
document with your child’s school at the beginning of each school year.
My name is __________________________________, and I hereby depose and certify as follows: (Please complete all
three (3) items and sign below)
1. I am the owner/daycare provider with property located at ___________________________ in the City of Marlborough.
My phone number is
. Name of daycare center (if applicable)
2. I provide daycare services for ___________________________, who is the parent or legal guardian of
__________________________, who I care for during the school year.
3. I have received within the last thirty (30) days payment for the care of
Signed under the pains and penalties of perjury this _____ day of
.
,
.
Signature: ___________________________________
Print Name: __________________________________
Print Address: ________________________________
Print Telephone Number: ________________________
This document must be notarized.
Commonwealth of Massachusetts
______________ss (County)
On this _____ day of ____________, 20__, before me, the undersigned notary
public, personally appeared ___________________________(name of document
signer), proved to me through satisfactory evidence of identification, which were
________________________, to be the person whose name is signed on the
preceding or attached document, and who swore or affirmed to me that the
contents of the document are truthful and accurate to the best of (his) (her)
knowledge and belief.
__________________ (official signature and seal of notary)
My commission expires ___________________________
It is the policy of the Marlborough Public Schools not to discriminate on the basis of race, gender, religion, national origin, color, homelessness, sexual orientation, age or disability in its
education programs, services, activities, or employment practices.
Marlborough Public Schools
Daycare Affidavit for Transportation Services
Instruções: Qualquer aluno em um ambiente de creche que recebe serviços de transporte de / para uma das Escolas Públicas de Marlborough deve
arquivar este depoimento concluída para receber esses serviços büsing do local creche. Por favor, envie este documento com a escola do seu filho
no início de cada ano letivo.
Meu nome é __________________________________, E eu por meio deste deponho e certifico o seguinte: (Por favor complete todos os três (3)
itens e assine abaixo)
1. E sou o dono/fornecedor da crèche com propriedade localizada no ___________________________ na Cidade de Marlborough. Meu número
de telefone é
. O nome da crèche é (se aplicavel)
2. Eu forneço serviços de crèche para ___________________________, quem são pais ou guardiões legais do/a ___________________________,
quem eu cuido durante o ano escolar.
3. Eu tenho recebido pagamentos dos últimos trinta dias (30) para o cuidado do/a
.
Assinado sob as dores e penalidades de falso testemunho isto _____ dia de
,
.
Assinatura: ___________________________________
Nome por escrito: __________________________________
Endereço: ________________________________
Numero de Telefone: ________________________
Esse documento deve ser notorizado.
____________________________________________________________________________________________________________________
Instrucciones: Cualquier estudiante en una guardería que recibe servicios de transporte a / desde una de las Escuelas Públicas de Marlborough
debe presentar esta declaración jurada para recibir los servicios de transporte escolar de la ubicación de la guardería. Por favor presentar este
documento con la escuela de su hijo a principios de cada año escolar.
Mi nombre es __________________________________ y aquí declaro y certifico lo siguiente: (Por favor, complete todos las tres (3) frases y firme
abajo)
1. Soy el dueño/proveedor de cuidado a niños(as) con una propiedad localizada en ___________________________ en la Cuidad de Marlborough.
Mi numero de teléfono es
. Nombre del centro (si aplica)
2. Proveo los servicios de cuidado para ___________________________, que es el padre o guardián legal de __________________________, a
quien cuido durante el año escolar.
3. En los últimos treinta días (30) he recibido pago por el cuidado de
Firmado bajo pena de perjurio el _____ día de
Firma: ___________________________________
Imprima el Nombre: __________________________________
Imprima la Dirección ________________________________
Imprima el Numero Telefónico: ________________________
Este documento debe ser notariado.
.
,
.