NYCA-FH Afterschool (PS 196Q Pick-up)

NYCA-FH Afterschool (PS 196Q Pick-up)

Exclusively for PS 196Q students. Please note that this form only authorizes pick-up. A separate registration for the NYCA afterschool program at our main location is strictly required.
Dear Parents/Guardians,

We are so excited to welcome your child to New York Chess Academy! For your convenience, we provide a free pick-up directly from PS 196Q. Because our top priority is the safety and security of our students during dismissal, we require all participating families to fill out this pick-up authorization form. This information helps us establish clear consent and logistical protocols for the afternoon transfer.

Important: PS 196Q will only release students to individuals on their official authorized pick-up list. To ensure a smooth transfer, please contact the main office and your child's homeroom teacher to add the following staff members to your list: Ivan Gil Biag, Khatia Abramidze, Michael Silvederio
Student's Full Name

First NameLast Name
Grade and Class Number
Homeroom Teacher
Day/s of pick-up
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Email
example@example.com
Parent/Guardian's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contacts
Anything else we need to know
Mandatory Consents & Acknowledgments
Signature
Please verify that you are human
Should be Empty: