Walker/Bike Rider and After School Care Registration & Agreement

Please complete one registration form per student. Any student who walks or bikes TO HOME, rides a bus or goes to Innovation Learning will need to complete a registration. Valid for the 2024-2025 school-year only. Please do not register your student to walk if you are parking down the street. You need to pick up your student through Driveline for their own SAFETY.

Student Last Name*

Student First Name*

Parent Last Name*

Parent First Name*

Parent Email*

Phone*

Homeroom Teacher*

Student Grade*

For students in grades K-3 - They cannot walk or bike ALONE, they have to have an older sibling PRESENT. If their older sibling is not at school that day, your K-3 student must be picked up through driveline.

Select

Transportation Mode*

How will your student depart from school if not being picked up by parent/guardian?

Select

Other:*

If your student is participating in the Innovation Learning program please list their grade and homeroom.

Home Address*

If a BUS will pick-up or drop-off your student please list the following:*

Company Name, Company Phone Number, Direct Contact Name

Parent Agreement*

I request that CSCA release my student(s) listed in this registration at regular dismissal time. I understand that Colorado Springs Charter Academy faculty/staff will no longer be responsible for my student(s) after 3:15 p.m. Monday-Thursday, after 1:30 p.m. on Fridays, and after dismissal on days with alternate dismissal times. I further understand that CSCA does not provide after-school supervision, access to telephone, facilities, or shelter during inclement weather for students once they have exited the building. This policy is subject to change at any time per school discretion. By typing my name in the box below I acknowledge that this electronic signature is the equivalent to a manual/handwritten signature on this agreement.

Send me a copy of my responses

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