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Dismissal Form 2016-17
The official school day at Blind Brook Middle School is from 7:50 AM – 2:40 PM. We recognize that at times it is necessary for students to be released from school prior to dismissal. To ensure the safety of our students and the least disruption to the learning environment, please adhere to the following procedures when planning for an early dismissal:

•Email Ms. Paisley (lpaisley@blindbrook.org) with the time and reason for early dismissal (i.e. 2:15 – orthodontist appointment);

•Sign your child out from the middle school main office (Students will only be called from class after you arrive in the main office)

•Only individuals listed on this form may sign students out of school. (They must bring picture ID each time)
PLEASE DO NOT ADD PARENT/GUARDIANS TO THIS LIST

PLEASE NOTE THAT PICTURE ID IS REQUIRED EVERY TIME THE STUDENT IS PICKED UP
ALSO, HIGH SCHOOL STUDENTS, SIBLINGS ARE PROHIBITED FROM PICKING UP FOR EARLY DISMISSAL

Students who return from an appointment may sign themselves back into school without a parent or guardian present. Students will receive a pass to return to class.

Student Last Name
Your answer
Student First Name
Your answer
Grade
#1 Person's Name Allowed to Pick-Up
Your answer
#1 Person Relationship
Your answer
#2 Person's Name Allowed to Pick-Up
Your answer
#2 Person Relationship
Your answer
#3 Person's Name Allowed to Pick-Up
Your answer
#3 Person Relationship
Your answer
#4 Person's Name Allowed to Pick-Up
Your answer
#4 Person Relationship
Your answer
Parent Filling Out Form
Please indicate your first and last name
Your answer
Submit
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