Dismissal Change Request - SAS at The Centre ONLY - READ BELOW BEFORE FILLING OUT
CHANGES MUST BE MADE PRIOR TO 2:15 PM.
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 (
) 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.
You must be requesting a TEMPORARY Dismissal Change only. If not, please go back and read the instructions above.
I confirm that I have read the instructions listed above and I am filling out a TEMPORARY end of school day dismissal change for one month or less.
Date of Change
If change is for more than one date, make sure to describe in Special Instructions below. If change is longer than one month, it must be treated as a permanent change.
Your Child's First Name
Your Child's Last Name
Your Child's Classroom Teacher (Lead)
HOW WILL YOUR CHILD BE GETTING HOME?
E.D.P. (MY STUDENT IS ALREADY REGISTERED)
(If not taking the bus, just put "N/A".)
THIS IS FOR ADDITIONAL DATES ONLY. If the change is longer than one month or permanent, do NOT fill out this form. New schedule must be emailed to the front desk and classroom teachers. (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
giving that person permission to pick up or adding them to your Approved Pick-up List. If they will have your pick-up hangtag, then you do not have to email.)
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