This form is to be completed only by the student's legal parent/guardian.  Please note that the Orenda Elementary School administration (or designee) reserves the right to contact you directly to verify the legitimacy of this form.  

If using this form, you do NOT need to call in the absence or submit a note when the student returns.

Parents/guardians requesting Pickup at Regular Dismissal Time (2:05 p.m.) for their student must submit this form by 10:30 a.m. on the day of pickup.  If you are requesting after 10:30 a.m., please contact Kristie Yacano in the Main Office (518-881-0550 x43425 or yacakris@shenschools.org) to have your student added to the Pick Up List. This must be done prior to 1:45 p.m. to allow sufficient time for communication among staff to take place concerning ALL students' dismissal plans. 

**The information you share in this form is confidential and shared only with staff directly involved in dismissal procedures.**

Thank you for your cooperation.