BRUNSWICK ACRES DISMISSAL CHANGE FORM
Directions: Please complete this form if you are requesting a dismissal change from your child(ren)'s usual dismissal procedure. This form must be submitted by 1:00 P.M. (11:00 A.M on Early Release Days). Verbal requests are not accepted. Your child's Student ID number is required to fill out this form. Student ID numbers can be found in the Genesis Parent Portal.

If you are requesting an EARLY DISMISSAL, please include all information in the EARLY DISMISSAL section.

Please complete a separate form for each day.
Email address *
DATE OF CHANGE *
MM
/
DD
/
YYYY
STUDENT'S LAST NAME *
Enter the student's LAST NAME. Please complete one form per student.
Your answer
STUDENT'S FIRST NAME *
Enter the student's FIRST NAME. Please complete one form per student.
Your answer
STUDENT'S ID NUMBER *
For security purposes, the student's 8 digit ID number is required. Student ID numbers can be found in the Genesis Parent Portal.
Your answer
TEACHER'S NAME *
DISMISSAL CHANGE *
(CHECK ALL THAT APPLY)
RIDE BUS HOME
NO BUS
GO TO AFTER SCHOOL
NO AFTER SCHOOL
WALK HOME TODAY
CAR LINE PICK UP
SIDE DOOR PICK UP
CLUB (ENTER NAME IN COMMENTS)
EARLY DISMISSAL (DETAILS BELOW)
Row 1
EARLY DISMISSAL
District policy states: Early dismissal from school is discouraged; however, we realize there are times when this will occur. The parent must come into the main office to sign the student out. Please enter the pick up person's name and the time of pick up. Children must be picked up by 3:00 PM. NO CHANGES AFTER 1:00 P.M.
Your answer
COMMENTS
Enter the name of the after school club or any other information related to the change.
Your answer
PARENT/GUARDIAN SIGNATURE *
Please enter your name as an electronic signature. By signing this form you acknowledge the district's policies and procedures regarding change in dismissals. Information can be found on the district web site in the Parent Handbook on pages 6.
Your answer
A copy of your responses will be emailed to the address you provided.
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