Palisades High School Early Dismissal Form (2025-26)

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Junior & Senior Students:

Please complete this form using your school district email.

Email *

Record my email address with my response

Name: (first & last) *

Grade: *

Period - click all the box(es) for the period in which you are requesting early dismissal. *

2 (days 135)

2 (days 246)

3 (days 135)

3 (days 246)

4 (days 135)

4 (days 246)

Required

Semester - Complete new form each semester. *

Semester 1

Semester 2

Guidelines and Procedures

Early dismissal permits are issued to provide an opportunity to work part time or to study at home. Students with fourth period early dismissal must leave the at the conclusion of period 3. Students with early dismissal privileges, who would like to remain in school to work with a teacher, must report to the attendance office with a pass from the supervising teacher. If a student has “C” lunch, they are permitted to leave the building before the start of “C” lunch. All students must leave the building through the main entrance of the building.

Early dismissal privileges will be revoked for failing grades, excessive absences (3 unexcused per semester), tardiness (6 unexcused lates per semester), loitering after leaving, or other unacceptable behavior as noted in the school handbook.

Date: *

YYYY

My electronic signature verifies that I have reviewed, along with my parent/guardian, and agree to follow early dismissal guidelines (please type first and last name). *

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