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 11:00 AM  (10:00 A.M on Early Release Days).  

IF YOU ARE FILLING THIS FORM OUT AFTER 11:00 A.M. PLEASE CONTACT THE MAIN OFFICE.
Student ID numbers can be found in the Genesis Parent Portal.

Please complete a separate form for EACH DAY and each Child.
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Email *
Date of Change *
MM
/
DD
/
YYYY
Day *
Student's Last Name
Please complete one form per student
 *
Student's First Name
Please complete one form per student
 *
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.
TEACHER *
Dismissal Change *
CHECK ALL THAT APPLY AND INDICATE DETAILS IN THE REASON SECTION. PARENT/GUARDIAN MUST COME TO MAIN ENTRANCE (Door A1) TO SIGN OUT EARLY DISMISSALS.
Required
Time of dismissal. *
Please indicate the TIME for early dismissal.
Time
:
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 building 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 P.M. on regular dismissal days and 1:00 P.M. on early release days.
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 website in the Parent Handbook.
Reason for dismissal change. *
A copy of your responses will be emailed to the address you provided.
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