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Khepera Charter School is a K-8 African-Centered Academy devoted to the Rebirth of Academic and Cultural Excellence.  It is a tuition-free Philadelphia public charter school.  


KHEPERA CHARTER SCHOOL
2015-2016 TRANSPORTATION REQUEST FORM
GRADES 1ST – 8TH (Kindergarten NOT Eligible)
 
STUDENT’S NAME: _________________________________________________
 
 
BIRTHDATE: ________________     GRADE: ___ TEACHER: _______________
 
 
ADDRESS: ____________________________________________________
 
 
BUS #: ___________________
 
Please check ALL that apply.
 
___YES, I am requesting BUS SERVICE for my child (grades 1st-5th).  I understand that if bus service is granted, I must live at least 1.5 miles away from Khepera Charter School according to the School District of Philadelphia.
 
            Pick Up Address Request: _________________________________
 
                        Cross Street: ______________________________________
 
            Drop Off  Address Request: ________________________________
                       
                        Cross Street: ______________________________________
 
___YES, I am requesting a free weekly STUDENT TRANSPASS for my child (grades 6th-8th).  I understand that if a free weekly student transpass is granted, I must live at least 1.5 miles away from Khepera Charter School according to the School District of Philadelphia.
 
PARENT’S NAME: _____________________________________________
 
PHONE NUMBERS:                                 
                                                Home:__________________________
 
                                                Work: __________________________
 
                                                Cell: ___________________________
 
EMERGENCY CONTACT: _________________________________________
 
PHONE NUMBERS:                                
                                               Home:___________________________
 
                                                Cell: ____________________________
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