Single Day Dismissal Plan Change
Complete this form if your child's dismissal plan changes (from their permanent dismissal plan) for a single day.  The form should be completed no later than 2:30pm.  If it is later than 2:30pm, please call our school office at 503-356-2150.  Note: If your child is going to be going home with a friend on a school bus, please write a note for your child to give to the bus driver in addition to completing this form.  Thank you!
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Email *
First name of STUDENT (not parent) *
Last name of student *
Student ID Number (if known)
Grade *
Teacher *
Date of dismissal change *
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Describe dismissal change (be specific) *
Parent/Guardian completing this form *
Date this form is being completed *
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Time this form is being completed (if you are completing this form after 2:30pm on the date of change, please call the office at 503-356-2150). *
Time
:
Cell Phone of person completing this form
A copy of your responses will be emailed to the address you provided.
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