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2. Please note, this form is intended to be filled out by Dubuque Community Schools or Holy Family School District employees on behalf of the student rider.
4. Jule Transit annual youth passes are renewable each year. Students must pay the annual fee to receive access each year. Annual youth passes are non-transferable, non-refundable, and not pro-rated and are valid August 1 to July 31.

   **Students must abide by The Jule’s Passenger Code of Conduct which is available at www.JuleTransit.org or risk suspension of service.

6. Please check the appropriate box:*

   1. New Card (6 - 10 years)
   2. New Card (11 - 18 years)
   3. Renewal Card (11 - 18 years)
   4. Replacement Card: $5 replacement fee is required to replace a lost or stolen card
8. Youth (Cardholder) Information
10. First Name*
11. Last Name*
13. Address*
14. Apt. or Unit
16. City*
17. State*
18. Zip*
20. Date of Birth
    Date of Birth
21. Phone #*
23. Email address:
25. School*
26. Current Grade*
28. Name(s) of Parent/Guardian*
29. Parent's/Guardian's Phone #(s):*
31. Please read and check the box below:

    I certify that the above information is true and correct. I understand my card is non-transferable and non-refundable and is valid August 1 through July 31. I recognize I must abide by The Jule’s Passenger Code of Conduct or risk losing or limiting my bus privileges. 

    1. I agree
33. Signature*
34. Today's Date*
    Today's Date
35. Card # (school use only):*
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field