Exhibit A–Out-of-District Grandparent Child Care

I declare that neither I nor my child(ren) live in the District attendance zone and that my child(ren)'s grandparent, ________________________ (print name of grandparent), residing at _______________________ (street address), __________________ (city), __________ (zip code), whose contact telephone number is ________________________, will provide after-school care for my child(ren), his or her grandchild(ren), listed below for at least three school days, each school week, at his or her District address above.

Student's Full Name



Grandparent's Zoned Campus

The aforementioned grandparent will provide care for the above child(ren) after school and, along with the parent, will be responsible for transportation to and/or from the zoned school. Students may ride the bus to and/or from the grandparent's home if bus transportation is normally provided by the District via established transportation guidelines.

No other transfer will be granted for students entering the District under provisions regarding a nonresident student in a grandparent's after-school care. A student will be required to attend only the zoned campus in which his or her grandparent resides.

Notarized by:

State of Texas

County of ______________________

Before me, a notary public, on this day personally appeared _____________________ (print parent's name) and _______________________ (print grandparent's name), known to me to be the persons whose names are subscribed in the foregoing document and, being by me first duly sworn, declared that the statements there in contained are true and correct.

Given under my hand and seal of office this _______ day of ______________, _________ (year).

Fort Bend ISD


LDU 2018.05

DATE ISSUED: 6/1/2018