Brookland Lakeview
21st Century Community Learning Center (21st CCLC)
2024-2025 TRANSPORTATION INFORMATION SHEET
BROOKLAND-LAKEVIEW COLA AFTERSCHOOL PROGRAM
Student's First Name
Student's Last Name
Drop-Off Address
Person at drop-off location
Cell # of person at of drop-off location
Home telephone of drop-off location
Email of person at drop-off location
Are there any special directions for this drop-off address?
Authorized persons to pick up your student from the Afterschool Program
Parent/Guardian Name
Street Address (No PO Box #)
I understand that my child must attend regularly, exhibit acceptable behavior, and be picked up promptly at dismissal time if she/he is a car rider.
I acknowledge that all the information given is correct to the best of my knowledge. I am the parent/guardian and have legal custody of the child being enrolled.
Parent Name
Date
