Early Dismissal Form

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If you are signing your child out of school before 1:35pm, please complete this form below, and expect a call from the Attendance Office to verify your child's' early dismissal details. Once verified, an early dismissal pass will be emailed to the student's email account. They should show this pass to their teacher and the front desk prior to leaving. All drivers picking up your child must be on the emergency contact list.

PLEASE DO NOT FILL THIS FORM OUT IF YOUR CHILD IS FEELING ILL AND WANTS TO BE PICKED UP Students who are not feeling well must report to the nurse. Parents will be called for dismissal.

THIS EARLY DISMISSAL FORM CAN ONLY BE FILLED OUT BY A PARENT/GUARDIAN, STUDENTS ARE NOT PERMITTED TO FILL OUT THIS FORM

Early Dismissal forms filled out by students will not be accepted.

Email *

Student First Name *

Student Last Name *

Reason for Early Dismissal - **DO NOT FILL OUT THIS FORM IF YOUR CHILD IS FEELING ILL AND WANTS TO BE PICKED UP** He/she must report to the nurse. A parent will be called by the nurse's office for dismissal. *

Early Dismissal Date *

YYYY

Time of Dismissal *

Time

Name of Adult signing the student out of school for Early Dismissal *

* * * PLEASE NOTE: FORMS FILLED OUT BY STUDENTS WILL NOT BE ACCEPTED. EARLY DISMISSAL FORMS MUST BE FILLED OUT BY A PARENT OR GUARDIAN

For students who are walking off campus (not being picked up):

If your child is not being picked up at the front of the building but will be walking off campus, please also email attendance @ mhsattendance@mahopac.org, the following:
I, (First Name, Last Name), give permission for (First Name, Last Name), to leave early and walk off campus on (date) at (time). (A pass will not be generated without receipt of both the form and email.)

Confirmation *

I am confirming that I am the legal guardian of the student named above. In addition, I give permission for the adult above to sign my child out of school on the date provided above. In addition, I understand my child will have to be picked up in the back of the building after 1:40PM

Required

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