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 (sasc@leonschools.net) 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. *
Required
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.
MM
/
DD
/
YYYY
Your Child's First Name *
Your answer
Your Child's Last Name *
Your answer
Your Child's Classroom Teacher (Lead) *
Your answer
What are their end of the day plans? *
Bus Stop *
(If not taking the bus, just put "N/A".)
Your answer
Additional Dates
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 sasc@leonschools.net 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.)
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of School of Arts and Sciences. Report Abuse - Terms of Service