P.R.I.D.E 2023/2024 Registration Form
Please contact Laurie Gresko lgresko@pottstownk12.org or Beth Mason bmason@pottstownk12.org.  Please note you will be notified by email that registration was received and what date your student can start.
P.R.I.D.E will begin September 5th for students in 5th & 6th grade and September 11th for students in 7th and 8th grade.
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Email *
Photos of my student may be taken for PSD/PRIDE social media and program promotional use *
Student Name *
Student email address *
My child attends *
Untitled Title
Parent/Guardian Name *
Home Address *
My child will attend P.R.I.D.E at the PMS for the 2023/2024 school year. *
My child will attend *Student must attend a minimum of 2 days per week. *
Required
My child is in 7th/8th grade and is interested in the Career and Tech Education (CTE) Program (after school) *Note: A tour of the program and CTE options will be offered the end of September with the program beginning in October. *
My child will be participating in after school sports and attend the program after for homework assistance. *
Transportation *
Required
Bus Agreement Contract
If your student will be riding a bus, please click on the option below so that we can send you a copy of the bus agreement in case you have not already signed one.

 *
My child's bus stop is *
Grade *
Homeroom *
Phone number *
Alternate Phone#
Does Your Child Have Insurance Coverage  ? *
Insurance  Company:  
Card #
Medical Assistance  Card (DPA) Card Number
Recipient
Please list any allergies that your child has or medication that they are on:  
Does your student have an IEP? *
Please list the name(s) of individual(s) (designees) other than yourself that you authorize to pick up your child. Please have these individuals bring and show a current photo ID to P.R.I.D.E  staff at time of pick up.:


 *
As the  parent/guardian: I hereby give P.R.I.D.E my permission to take photos of my child for social media and marketing purposes to promote the program. (Electronic Signature Approval)  *
Additional notes that the P.R.I.D.E staff should know.
As the  parent/guardian : I hereby give my permission to attend the 2023/2024 P.R.I.D.E program. (Electronic Signature Approval):  *
Date of Electronic Signature:  *
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P.R.I.D.E is a 21st Century Community Learning Center program Sponsored by the Pennsylvania Department of Education
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