CV Primary School Early Dismissal/End of Day Pick Up Form
Please complete this form to ensure that the CVPS office receives documentation of a planned early dismissal or pick up for your child. All forms must be submitted prior to 3:00 pm on the day of dismissal. Thank you in advance for your cooperation!

If an emergency arises once this form is submitted, please contact the CVPS office at (412) 429-3270.

Email address *
Date of Pick Up *
MM
/
DD
/
YYYY
Time of Pick Up (Dismissals not permitted between 3:10 - 3:35.) Times may be from 9:00-3:00 or 3:35 for end of the day pick up. *
Time
:
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Homeroom Teacher *
Last Name of Individual Picking Up Student *
Your answer
First Name of Individual Picking Up Student *
Your answer
Reason for Pick Up Request *
Required
Is the student returning to school? *
A copy of your responses will be emailed to the address you provided.
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