2018-19 Dismissal Authorization Form
Use the form below to list the dismissal information for your child or children, one per child. Thank you! Due June 20th
Child's Last Name (Please fill out one form per child)
Child's First Name
Child's Grade (2018-19)
Bus - AM
Carpool/Parent - AM
Bus - PM
Carpool/Parent - PM
Notes: Please indicate any special dismissal arrangements or varied schedules here
Carpool Participants Names (if applicable)
Additional Authorization: Please list any people that you authorize BPY to release your child to i.e. babysitter, grandparent, friend, etc. :
I hereby authorize Ben Porat Yosef to allow my child to be released from school with the above listed people. (Please sign and date)
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