Change in Dismissal Form

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Please fill out this form if you would like to change your child's dismissal for the day, week or on a permanent basis. Requests for a daily change MUST be received before 1:00 p.m. the day of the change (the Wednesday deadline is 10:30). Any requests after those time stamps cannot be processed in time. Please do not call the office or email the teacher as we cannot guarantee that the information will be processed. As always, you may send in a written note with dismissal changes to the office.

Email *

Date For Change

YYYY

Child's First Name:

Child's Last Name:

Child's Teacher:

Check only one box

Ms. Burgess - K

Mrs. Pena - K

Mrs. Spencer - K

Mrs. Hodsdon - 1st

Ms. Vitale - 1st

Ms. Ashley - 1st

Mrs. Gallahue - 2nd

Mrs. Auger - 2nd

Mrs. Ganss - 3rd

Ms. Norsworthy - 3rd

Ms. Drysdale - 3rd

Ms. Ryder - 4th

Ms. Boyle - 4th

Mrs. Meek - 5th

Mrs. Farley - 5th

Mrs. Kelley - 5th

Mrs. White - 6th

Mrs. Wilcox - 6th

Mrs. Lemieux - 6th

Change requested:

Cancel daily pick-up. Please send my child on regular bus to HOME.

Cancel extended day (must let them know separately). My child instead will:

I would like to pick up my child at dismissal (3:20 MTTHF/12:50 W). Do not send on bus.

I would like to pick my child up early. Please indicate time below

Other

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