Pakachoag Dismissal Form 2021-2022
Student safety is of the utmost importance. It is essential that we have up to date information as to how your child goes home at the end of the school day. Thank you for helping us keep your child safe!

Please remember that the deadline has passed for bus applications. Please contact the Central Office with any bus questions.

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PLEASE COMPLETE BY MONDAY, AUGUST 23rd
Child's First Name *
Child's Last Name *
My child will be in: *
Teacher's Name *
My child's afternoon bus number is: *
On Monday afternoon, my child will be a: *
Required
On Tuesday afternoon, my child will be a: *
Required
On Wednesday afternoon, my child will be a: *
Required
On Thursday afternoon, my child will be a: *
Required
On Friday afternoon, my child will be a: *
Required
Parent/Guardian #1's Name *
Parent/Guardian #1's Address *
Parent/Guardian #1's Phone Number *
Parent/Guardian #1's Email Address *
Parent/Guardian #2's Name
Parent/Guardian #2's Address
Parent/Guardian #2's Phone Number
Parent/Guardian #2's Email Address
List of people who have permission to pick up your child from school or at the bus stop. *
Any other information that will support the safe dismissal of your child.
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