Request for Dismissal Change Form

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Parents/Guardians: You must complete this form and wait to be notified by the Assistant Principal. This form is reviewed daily at the end of the school day. Please allow 24-48 hours for a confirmation response. If you have any questions please call the school immediately at 410-887-0823 or communicate it to your child's teacher.

Email *

TODAY'S DATE *

YYYY

STUDENT NAME *

GRADE LEVEL *

Pre-k

Kindergarten

First

Second

Third

Fourth

Fifth

WHAT IS THE NAME OF YOUR CHILD'S TEACHER *

WHAT IS YOUR NAME? *

WHAT IS YOUR PHONE NUMBER? *

WHAT IS THE REASON YOU ARE REQUESTING A DISMISSAL CHANGE? *

WHICH WAY IS THE STUDENT DISMISSING NOW? *

CAR

BUS

WALKER

IS THIS A PERMANENT CHANGE? *

Yes

Other:

PLEASE INDICATE THE START DATE YOU NEED THIS DISMISSAL CHANGE TO BEGIN-Please note until you receive an approval notice from an administrator the dismissal process will remain the same. This process will take 24-48 hours. *

YYYY

WHICH WAY DO YOU WANT TO THE CHILD TO GO HOME? *

BUS

CAR RIDER

WALKER

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