Non-Parent/Guardian Early Dismissal Form 2018-2019
Email address *
This form is used by parents or guardians to notify LLCS that an adult other than the parent/guardian and/or persons listed as "authorized for pick up" will be signing out your child(ren) prior to regular dismissal. Prior to releasing any students, proof of ID will be required by the person you are allowing to sign-out your child(ren).
Your name *
Your answer
Name of person you grant permission to sign your child(ren) out. He/She will have to provide a drivers license or other form of identification. *
Your answer
Approximate Time of Sign Out: *
The person signing your child(ren) out will complete the official sign-out form upon arrival to school.
Type the FIRST and LAST name(s) of your child(ren) being signed out early followed by grade level. *
EXAMPLE: Jane Doe 5th, John Doe 10th
Your answer
Absent Due to Early Dismissal: Per the Parent/Guardian and Student handbook, students receive a DAILY absence when one of the following occur during the school day (full day or half day): Students do not attend four consecutive hours, Students leave before 12:00 noon, Students arrive after 11:00am. Students in grades 4 - 12 receive a MEETING absence when a class is missed.
I understand the "Absent Due to Early Dismissal" statement above. *
A copy of your responses will be emailed to the address you provided.
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