Early dismissal request

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Early dismissals may be requested up to three (3) days ahead of the day your student will be leaving early. Please fill out all questions completely. You will receive an email copy of your responses, which you may print for your student if you wish. The student does not need a printed form, they may simply tell their teacher that they are signing out and proceed to the office.

Email *

Parent/Guardian Name (first and last) *

Parent/Guardian Phone Number, with Area Code *

Student Name (first and last) *

Date of early dismissal (Please only request dismissals for the next 3 days) *

YYYY

Time of early dismissal *

Time

Reason for early dismissal *

Doctor Appointment

Orthodontist/Dentist Appointment

Eye Doctor Appointment

Physical Therapy

Chiropractor

Funeral

Other:

Please select one choice below: *

My student is aware of the appointment and knows to sign out at the office.

My student does NOT know about this appointment, please call them down to the office.

A copy of your responses will be emailed to the address you provided.

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