Discovery Elementary School Dismissal Change Form
This form is to be used when your child’s after school dismissal plans temporarily change.  Please fill this form out completely. All dismissal changes must be in writing, signed by the parent or legal guardian, and received by 2:15 p.m.   We cannot accept phone calls or e‐mails to change dismissal plans.  
Email address *
Date of Dismissal Change *
MM
/
DD
/
YYYY
Parent Phone Number *
Your answer
Important Safety Information
Photo identification is required of anyone picking up a child from school. Students will only be released to persons listed as an emergency contact for that student.
Child's Last Name *
Your answer
Child's First Name *
Your answer
Parent's Last Name *
Your answer
Parent's First Name
Your answer
Child's Teacher *
Your answer
Regular Dismissal Plan *
If Regular Dismissal is Bus or After-School Care, Which One (Bus Number or After Care Provider)?
Your answer
Temporary Change of Dismissal Requested *
If Change Requested is Bus or After-School Care, Which One (Bus Number, After Care Provider)?
Your answer
If Change Requested is Car Pick Up, Who will be picking the student up?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Loudoun County Public Schools. Report Abuse - Terms of Service