Douglas School Daily Dismissal Change Form
Please note this form is a newly created for the 2023-2024 school year 

This form is to be used to:
  * change a students dismissal from a bus rider to a walker or
  * to pick up a student early or
  * to change WHO is picking up a student or
  * to change the dismissal location of a student
  * to change from a walker to a bus rider
The deadline to submit this form is 9:30 a.m. The form will close at that time and reopen at the end of the school day (M,T,Th,F - 4:00pm; Wed 1:00pm)
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Email *
Date (the effective date of the change) *
MM
/
DD
/
YYYY
Type of Change (Please check one) *
If Permanent Change, Please Check All Applicable Days
Child's First Name *
Child's Last Name *
Child's Grade Level *
Required
Child's Teacher's Name *
Required
Dismissal / Pickup Time *
Time
:
Dismissal Change for student (choose one) *
If your child will be a walker, please type in the following information below.

1.) If they will be released to an adult, please list the name of the person picking up your child or

2.) If they will be released on their own without adult supervision, please list their specific destination (example: Home, West Side Creamery, New London Pizza, friend's name and address, etc.). Note: only grade 2-6 students may be dismissed without adult supervision.
 *
Phone Number where parent can be reached
 *
A copy of your responses will be emailed to the address you provided.
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