Dismissal Change Form

Dismissal Change Form

DUE FIRST THING IN THE MORNING, IN YOUR CHILD’S BACKPACK

Required only if you are deviating from your normal dismissal schedule. One form for each child.

Today’s Date: _______________________              Teacher: ________________________________________

Student’s Full Name: ________________________________________________________________________

My child’s dismissal will change for the following date(s): ___________________________________________

___ My child will not be taking the bus today as normally scheduled.

       The following person will be picking up my child today _____________________________________________.

___ My child will not be going to daycare today as normally scheduled.

       The following person will be picking up my child today _____________________________________________.

___ My child will not be going to daycare today as normally scheduled.

       My child has a bus pass and will ride Bus # ________ home today.

___ My child will be leaving early today at ____________ AM/PM.

       The following person will be picking up my child today _____________________________________________.

___ My child is regularly a Walker and will be picked up by a different person today.

       The following person will be picking up my child today _____________________________________________.

___ Other, please explain:

__________________________________________________________________________________________

__________________________________________________________________________________________

 

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Parent/Guardian Signature

 

Please remember to bring proper identification.