2017-18 Dismissal Authorization Form
Use the form below to list the dismissal information for your child or children, one per child. Thank you!, Due July 1
Child's Last Name (Please fill out one form per child) *
Your answer
Child's First Name *
Your answer
Child's Grade (2017-18) *
AM Tranportation: *
PM Tranportation: *
Carpool Participants Names (if applicable)
Your answer
Additional Authorization: Please list any people that you authorize BPY to release your child to i.e. babysitter, grandparent, friend, etc. : *
Your answer
I hereby authorize Ben Porat Yosef to allow my child to be released from school with the above listed people. (Please sign and date) *
Your answer
Your answer
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