Act 372

The purpose of this form is to document student registration for those living in Hatboro-Horsham School District, but attending Non-Public Schools. This form will be a way of updating important contact information, as well as replacing the Act 372 Form as your formal request for transportation services from Hatboro-Horsham School District. Use of this information will allow us to contact you using Blackboard Messenger (via text, email or phone) for emergency messages, like weather related closings, vehicles running late, etc. Additionally, this information will allow us to better serve you when our Here Comes the Bus Parent Application goes liveat the start of the school year. Please note that transportation will not be provided unless this form is completed and residency is verified through Montgomery County. This must be filled out for each student. Please complete the form by May 16, 2022.

1.	Student Last Name*

2.	Student First Name*

3.	Student Date of Birth*
	mm/dd/yyyy

4.	Student Grade Level
	--None--K123456789101112

5.	School*
	School* ABINGTON FRIENDS SCHOOL ACADEMY OF THE NEW CHURCH ANCILLAE ASSUMPTA ACADEMY ARCHBISHOP WOOD HIGH SCHOOL BRYN ATHYN CHURCH SCHOOL Calvary Baptist CALVARY CHRISTIAN ACADEMY CENTER SCHOOL CREFELD DOCK MENNONITE ACADEMY, SOUDERTON GERMANTOWN ACADEMY GOOD SHEPHERD CATHOLIC SCHOOL GWYNEDD MERCY HIGH SCHOOL GWYNEDD MERCY ACADEMY ELEMENTARY LA SALLE COLLEGE HIGH SCHOOL LANSDALE CATHOLIC HIGH SCHOOL MARY MOTHER OF THE REDEEMER CATHOLIC SCHOOL MAST COMMUNITY CHARTER MOUNT SAINT JOSEPH ACADEMY NATIVITY OF OUR LORD SCHOOL NORWOOD FONTBONNE ACADEMY OUR LADY OF MERCY REGIONAL CATHOLIC SCHOOL PERELMAN JEWISH DAY SCHOOL-FORMAN PHILMONT CHRISTIAN ACADEMY QUEEN OF ANGELS REGIONAL CATHOLIC SCHOOL REGINA COELI ACADEMY SPRINGSIDE CHESTNUT HILL ACADEMY ST CHRISTOPHER ST HILARY SCHOOL ST JOSEPH/ST ROBERTS SCHOOL St Katherine of Drexel THE MONTESSORI SCHOOL Twin Spring Day Farm VALLEY CHRISTIAN SCHOOL Villa St Joseph Marie If you do not see your school listed, please specify

6.	Student's House # & Street (i.e. 158 Maple Avenue)*

7.	Student's City
	Student's City Ambler Hatboro Horsham Maple Glen North Wales Other, please specify

8.	Student's State

9.	Student's Zip Code
	Student's Zip Code 19002 19040 19044 19454 Other, please specify

10.	Parent/Guardian 1 Name *

11.	Parent/Guardian Cell Phone Number

12.	Parent/Guardian Home Phone Number

13.	Parent/Guardian Work Phone Number

14.	Parent/Guardian 1 Email Address*

15.	Parent/Guardian 2 Name

16.	Parent/Guardian 2 Cell Phone Number

17.	Parent/Guardian 2 Home Phone Number

18.	Parent/Guardian 2 Work Phone Number

19.	Parent/Guardian 2 Email Address

20.	What type of transportation is required?*
	What type of transportation is required?* Morning Afternoon Both None

21.	Person(s) allowed to meet student at the bus stop. Place an X in the Yes column. Please place the X under No for individuals who are not allowed to meet the student.
	Contact Name   Yes   No Contact 1       Contact 2       Contact 3

22.	Email of the Parent/Guardian completing the form*

23.	Person Completing This Form (this is considered to be the signature)*