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RAPCS 2024-2025 After School Program Permission Slip

Richard Allen Preparatory Charter School

2601 S 58th Street, Philadelphia, PA 19143

Phone: 215-878-1544

Fax: 215-727-0711

RAPCS_LOGOFINAL

By completing this form, you are allowing your child to stay after school to partake in school-sponsored activities. The activities covered under this permission slip include school-sponsored sports programs, academic clubs, enrichment activities, and any other school-sponsored activity that would require your child to remain on the premises beyond the normal school hours of operation at any designated time throughout the school year. Your child will stay in the Cafeteria (MPR) until their activity starts, under the supervision of RAPCS staff.

Child's Last Name*

Answer required for "Child's Last Name"

Child's First Name*

Answer required for "Child's First Name"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal Code*

Answer required for "Zip/Postal Code"

Parent/Guardian's Name*

Answer required for "Parent/Guardian's Name"

Parent/Guardian's Phone Number*

Number Required

Parent/Guardian's Email*

Answer required for "Parent/Guardian's Email"

Emergency Contact's Name*

Answer required for "Emergency Contact's Name"

Emergency Contact's Phone Number*

Number Required

Please list any of your child's allergies and/or medical conditions. *

Answer required for "Please list any of your child's allergies and/or medical conditions. "

Parent/Guardian's ID

Answer required for "Parent/Guardian's ID"

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Parent/Guardian's Signature*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"