P.R.I.D.E 2019/20 Online Registration Form
Please fill out the form below and hit "Submit" at the bottom of the page. Do not hit "Request Access to Edit" at the top of the page or your information will not be saved.
Please contact Megan McCain or Jennifer Furniss with any questions.
My child will attend P.R.I.D.E at the PMS for the 2019/20 school year
Both Before School and After School
Before School Only
After School Only
My child will attend
Friday (before school only)
My child is in 7th/8th grade and is interested in the Career and Tech Education Program (after school)
My child will need busing to the before school program
My child will need busing home from the after school program
My child will be dismissed and walk home daily from the Pottstown Middle School.
My child's bus stop is
Beech & Adams
Queen & Madison
Queen & Roland
Rose Ct & Cherry Lane
Keim & Wilson
Washington & Prospect
Washington & Mervine
Hanover & Prospect
Beech & Franklin
Franklin & South
W King & Gable
W King & Potts
Myrtle & W Walnut
Manatawny & Glasgow
Manatawny & Upland
Manatawny & 4th
Beech & York
State & 8th
My Child WIll Walk To/From School
Student ID Number
Does Your Child Have Insurance Coverage ?
Medical Assistance Card (DPA) Card Number
Please list any allergies that your child has:
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)
As the parent/guardian : I hereby give my permission to attend the 2019/20 P.R.I.D.E program. (Electronic Signature Approval)
Date of Electronic Signature
P.R.I.D.E is a 21st Century Community Learning Center program Sponsored by the Pennsylvania Department of Education
Send me a copy of my responses.
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