23-24 CV Intermediate School Dismissal Form

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Please complete this form to ensure that the CVIS office receives documentation of a planned dismissal for your child. All forms MUST BE SUBMITTED prior to 1:30 pm on the day of dismissal. Thank you in advance for your cooperation!

If an emergency arises once this form is submitted, please contact the CVIS office at (412) 429-2236.

Email *

Date of Dismissal *

YYYY

Type of Dismissal (If submitting after 1:30 PM, please email isattendance@cvsd.net to ensure your student is accounted for.) *

Last Name of Student Being Dismissed *

First Name of Student Being Dismissed *

Student's Homeroom Teacher *

Last Name of Individual Picking Up Student *

First Name of Individual Picking Up Student *

If you have a Pick Up Placard number, please enter it below

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