This form is to be completed only by the student's legal parent/guardian.  Please note that the Shatekon Elementary School administration (or designee) reserves the right to contact you directly to verify the legitimacy of this form.  

If using this form, you do NOT need to call in the absence or submit a note when the student returns.

Parents/guardians requesting Pickup at Regular Dismissal Time for their student must submit this form by 10:30 a.m. on the day of pickup.  If you are requesting after 10:30 a.m., please contact Candace Cady in  the Attendance Office (518-881-0584) to have your student added to the Pick Up List.

**The information you share in this form is confidential and shared only with the office staff and nurse.**

Thank you for your cooperation.