Early Emergency Dismissal Form

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In the event of an early school closing, it's essential that we know the plan for your child as we understand there may be unexpected circumstances that prevent students from following their typical dismissal routine.
Please complete this form by Nov. 30 to help ensure that a plan is in place for your child to prioritize safety in the event that the school day is unexpectedly shortened and students are dismissed early. Communication regarding an early or emergency will be sent via the Blackboard Connect message system. If your child is to go home, please ensure that appropriate supervision is waiting for them when they arrive. It is crucial that your child understands the plan for early or emergency release as submitted on this form.

Student Legal Name *

Grade Level *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Teacher Name *

In the event of an early, unplanned dismissal, my child is to... (Please select one choice). *

Ride their regularly assigned bus

I will pick up my child

My child should walk home (our house is in the Pinebrook walk zone)

My child is to go to their regularly scheduled Daycare

My child will walk home with or picked up by* (if you select this option, please complete the next question)

Please follow my child's Standard Afterschool Dismissal Plan (Please note that CASA will be closed in the event of an early school closing)

*I selected "my child will walk home with or picked up by" and this person is listed as an emergency contact in ParentVue for my child (include student name and name(s) of adult that will pick up your child)

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