2021-22 Manheim Township School District                       Non-Public Emergency Contact Form
In order to receive transportation for your student, this form will need to be filled out int its entirety and submitted annually. When transportation has been arranged for your student, you will be notified via email. For transportation to be started by the first day of school, this form needs to be filled out by June 15, 2021. For any changes throughout the school year, please contact us at Transportation@mtwp.net
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Email *
Student's First and Last Name *
As a Parent/Guardian of the student name listed above, I hereby acknowledge that my student will wear a face mask while riding on buses/vans operated on behalf of the Manheim Township School District, both to and from school. For a copy of the full Resolution of the Board of School Directors regarding our face mask mandate, please contact the MTSD Transportation Department. (Please enter your initials below) *
School of Attendance *
Student's Birthday *
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DD
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Grade (21-22) *
Home Address *
Home Phone Number *
Parent or Guardian 1 Full Name *
Parent or Guardian 1 Cell Phone Number *
Parent or Guardian 1 Email address *
Parent or Guardian 1 Employer *
Parent or Guardian 2 Full Name
Parent or Guardian 2 Cell Phone Number
Parent or Guardian 2 Email Address
Parent or Guardian 2 Employer
Alternate Contact Name
Alternate Contact Phone Number
Allergies, Medications, or Additional Comments *
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