Dismissal Form
If I would like to change any of the dismissal options I selected below: I will let the school office know by telephone before 2PM or by sending a signed, dated note to the school office, excluding last minute emergencies. Please complete 1 per student.
Email address *
Student Name *
Your answer
Student Grade *
Walking Transportation
Walking Transportation *
Car Transportation
Car Transportation *
Extended Care
My student will need extended care on the days I have checked below. Students who are not picked up by 2:35 will be brought to Extended Care. Students are prohibited from waiting for parents/guardians outside after this time. This is for your student's overall safety.
Days of the week, my student will need Extended Care *
Persons authorized to pick up my student.
Under no circumstances will your student be released to anyone not known to the school without written authorization from a parent or guardian. (we will ask for ID)
Please list all persons authorized to pick up your student, include full name and relationship. *
Your answer
Are there any individuals restricted from picking up your son/daughter? Must provide legal documentation to the office.
Please list all persons full name who restricted from picking up your student.
Your answer
By electronic signature I agree to the above stated terms, if any changes are to occur to this agreement, I will notify the school office.
Please type your full name *
Your answer
Include today's date *
A copy of your responses will be emailed to the address you provided.
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