2024-2025 Hopewell Elementary School's Dismissal Waiver
Please review the various choices below, and make a selection for each day of the week.

In the event that there is a change in dismissal plans, please email the office staff at hwmainoffice@hvrsd.org as well as your student's teacher as soon as possible.

Please complete one form for each student that attends Hopewell Elementary School.  Forms should be completed before the start of school on September 3rd.

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Definition of Dismissal Terms

Walker - The parent / guardian gives permission for the student to be dismissed to 'walk' either to home or to the parent / guardian car themselves.   
  • By selecting this option, the signer gives permission for the named child to leave school on his/her own at dismissal time, and assumes responsibility for arranging any necessary supervision upon such release.
  • Students will exit to The Frog in the large parking lot off of Princeton Avenue.
Supervised Pick Up - The parent / guardian wishes to pick the student up directly from Hopewell Elementary Staff Member.
  • By selecting this option, the signer wishes to personally receive the named child at dismissal time, and agrees to wait at the  designated area for personal identification and pick up. The individuals named below are the  following person(s) as approved to receive my child (limit of three, please).
  • Students will exit to The Frog in the large parking lot off of Princeton Avenue.  A staff member must see the authorized adult.
After Care - The parent / guardian has enrolled the student into the YMCA After Care Program, and the student will be released to YMCA staff upon dismissal.

Bus Rider - The student has a designated bus route.

Enrichments - If your child participates in an enrichment program throughout the year, dismissal plans will be arranged accordingly at that time.

Student's LAST Name: *
Student's FIRST Name:
 *
Grade Level:
 *
Student's Homeroom Teacher *
Mondays:
 *
Tuesdays: *
Wednesdays: *
Thursdays: *
Fridays: *
Designated Individuals for Supervised Pick Up.
The individuals named below are the following person(s) as approved to receive my child (limit of three, please).
Alternate Supervised Pick Up / Teacher Hand Off #1
If you have selected Parent Pick Up / Teacher Hand Off, please indicate the individual(s) approved to pick up your student.  Please include Name, Relationship and Phone Number.
Alternate Supervised Pick Up / Teacher Hand Off #2
If you have selected Parent Pick Up / Teacher Hand Off, please indicate the individual(s) approved to pick up your student.  Please include Name, Relationship and Phone Number.
Alternate Supervised Pick Up / Teacher Hand Off #3
If you have selected Parent Pick Up / Teacher Hand Off, please indicate the individual(s) approved to pick up your student.  Please include Name, Relationship and Phone Number.
Until otherwise informed, using this form, school officials will limit the release of the student upon dismissal to the parent or legal guardian only.

Completion of this box by typing your name is your signature.
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