Cedar Hill Regular Dismissal Schedule 17-18
Dear Parent/Guardian,

All schools must have accurate dismissal information for all students. Please complete the entire form, sign at the bottom, and submit the form BEFORE the FIRST DAY of school. Please complete a SEPARATE FORM for each of your children.

Thanks,

Mr. Ciempola and Mrs. Uhler

Email address
A. Child's First Name
Your answer
B. Child's Last Name
Your answer
C. Home Phone Number (xxx)xxx-xxxx
Your answer
D. Parent 1 Cell Phone Number (xxx)xxx-xxxx
Your answer
E. Parent 1 Work Phone Number (xxx)xxx-xxxx
Your answer
F. Parent 2 Cell Phone Number (xxx)xxx-xxxx
Your answer
G. Parent 2 Work Phone Number (xxx)xxx-xxxx
Your answer
H. If carpooling, name of Pick-up person(s)
Your answer
I. Pick-up person(s) phone number
Your answer
J. Relationship(s) to student if other than parent:
Your answer
K. List students who are carpooling together:
Your answer
L. Current Grade
M. Teacher's Last Name
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