Temporary Change of Dismissal Form
Thank you for informing us about this change in your child's dismissal.

You do not need to confirm receipt of this form. Our office team has on-demand access to the submissions.

Please remember that photo identification is required of anyone picking up a child from school. Parents and legal guardians must give written consent for any other persons to remove their child from school even if that person is listed on the child’s emergency procedure card. Emergency contacts listed on your child’s emergency procedure card are persons you give the school permission to contact if you cannot be reached during the school day and your child needs to be picked up in the event of an unexpected emergency such as an illness or injury.

If someone other than you will be picking up your child, it is best practice to forward to that person the email receipt you will receive soon after completing this form.

NOTE: If the change you are requesting will impact another student or family, it is REQUIRED that both families complete this form. Student safety is our primary concern, and we want to minimize any inconvenience this required procedure may cause.

*Dismissal window closes at 2:30pm *
Email address *
Date of Dismissal Change *
MM
/
DD
/
YYYY
Student's Last Name *
Student's First Name *
Grade Level of Student *
Child's Teacher *
Regular Dismissal Plan *
Type of Temporary Change of Dismissal Requested *
If early dismissal, what time?
Time
:
Additional Details (ie. Provide Bus #, Pick-Up Person, etc) *
Last Name of Parent/Guardian *
First Name of Parent/Guardian *
Phone Number of Parent/Guardian *
Important Safety Information
Photo identification is required of anyone picking up a child from school. Parents and legal guardians must give written consent for any other persons to remove their child from school even if that person is listed on the child’s emergency procedure card. Emergency contacts listed on your child’s emergency procedure card are persons you give the school permission to contact if you cannot be reached during the school day and your child needs to be picked up in the event of an unexpected emergency such as an illness or injury.
A copy of your responses will be emailed to the address you provided.
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