This form is only for TEMPORARY changes to normal END OF SCHOOL DAY (3:10 pm) dismissal.
This form can be filled out by a Parent/Legal Guardian only. If you are having someone pick up your child that is not listed on your Emergency Contacts/Approved Pick-up List on the Clinic Card, you must email the front desk giving that person permission to pick up or adding them to your Approved Pick-up List.
If the change is longer than one month, it must be treated as a PERMANENT CHANGE. Do NOT fill this form out if there is a permanent change. Instead, the new dismissal schedule must be emailed to the front desk (email@example.com) and the classroom teachers.
EARLY PICKUP (before 3:10 pm): If you are picking up your child before the 3:10 dismissal, you do NOT fill out this form. If someone other than the student's parent/guardian is picking up early (before 3:10), the parent/guardian must email the front desk giving the person permission to pick up early.