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Student Afternoon Dismissal Form
Please indicate how your child will be picked up from school
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* Indicates required question
Guardian Email(s)
*
Your answer
Student Name
*
Your answer
Grade
*
K
1
2
3
4
5
6
7
8
Required
Classroom Number
*
Your answer
Method of Pick-up
*
Car Rider
Walker
Sibling Pick-up
After-School Program
School Bus
Septa
Required
If Sibling Pickup, provide name and grade of sibling
Your answer
After-School Program student is enrolled in
3 Queens Yoga
Butcher’s Sew Shop
Capitolo Rec Center
E.O.M.
Fleisher Art Memorial
In Movement
Old Pine Community Center
Philly PACK
Queen Village Art Center
Settlement Music School
Shot Tower Rec Center
Zhan Sah
Stem Works Studio
Other:
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