Shajara Tayyiba Student Late Pick Up Form

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Shajara Tayyiba Student Late Pick Up Form

All parents / carpool drivers who pick up student(s) from school after 3:30 pm must complete this form before student(s) are released.

It will be the parent's responsibility to pay the late fee before the end of the term regardless of carpool

Late Pick Up Fee is $1/child/minute

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* Indicates required question

Student Name (if picking up more than one child, please list all names) *

Your answer

Parent Name *

Your answer

Name of Carpool Driver, if not parent not picking up

Your answer

By checking this box I agree to pay the $1/child/minute late fee before the end of the term *

I agree

Required

Total late fee amount *

Your answer

Submit

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