Parent/Guardian Permanent Pickup
Please use to request permanent parent/guardian pickup. Students will be picked up in the 6th grade pod at dismissal. We request that parents/guardians do NOT pickup up students in office at dismissal time, which begins at 3:10.
Student Last Name *
Your answer
Student First Name *
Your answer
Teacher Name/Room Number (Grade)
Start Date Dismissal - Permanent Pick-up *
Date student will begin permanent parent/guardian picked up.
MM
/
DD
/
YYYY
Permanent Pick-up
Select individual day of the week for permanent pick-up
Permanent Pick-up
Select individual day of the week for permanent pick-up
Permanent Pick-up
Select individual day of the week for permanent pick-up
Permanent Pick-up
Select individual day of the week for permanent pick-up
Permanent Pick-up
Select individual day of the week for permanent pick-up
Parent Contact CELL PHONE Number *
Please provide a cell phone number (xxx-xxx-xxxx) in case we need to contact you.
Your answer
You must select "yes" to electronically sign this request *
Person Picking Student Up *
Please provide name of person picking student up if NOT parent.
Submit
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