CV Intermediate School Early Dismissal Form
Please complete this form to ensure that the CVIS office receives documentation of a planned early dismissal for your child. All forms must be submitted prior to 3:00 pm on the day of dismissal. Thank you in advance for your cooperation!

If an emergency arises once this form is submitted, please contact the CVIS office at (412) 429-2236.
Email address *
Date of Early Dismissal Request *
MM
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DD
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YYYY
Time of Early Dismissal (no dismissals permitted between 3:10 - 3:35) *
Time
:
Last Name of Student Being Dismissed *
Your answer
First Name of Student Being Dismissed *
Your answer
Child's Homeroom Teacher *
Last Name of Individual Picking Up Student *
Your answer
First Name of Individual Picking Up Student *
Your answer
Reason for Early Dismissal Request *
Required
Is the student returning to school? *
A copy of your responses will be emailed to the address you provided.
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