24-25 PM Dismissal - Daily Car Rider Request
Please complete this form if your child will be an afternoon (PM) car riders for the 23-24  school year. Please complete one per child.

This form will be available until Friday, September 1st. After Friday, September 1st, please contact our main office directly to make car rider changes or updates. If more detailed information is needed please submit to our main office in writing/email. sstephanski@voluntownct.org
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Email *
Student's First Name *
Student's Last Name *
My child will *
Authorized pick-up: First Name, Last Name and Relationship *
Authorized pick-up: First Name, Last Name and Relationship
Authorized pick-up: First Name, Last Name and Relationship
Authorized pick-up: First Name, Last Name and Relationship
Authorized pick-up: First Name, Last Name and Relationship
Please check the days for Car Rider pick-up. Check all that apply.   *
Required
Other Information Needed to Note:
Parent/Guardian Signature: The following individual has submitted this form with consent for car rider pick-up with the individuals listed on this form. Please type name, phone number and relationship to student. *
A copy of your responses will be emailed to the address you provided.
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