HS Early Dismissal Form 2023-24

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form must be completed by a Parent/Guardian.

After the form is completed:

1) The student MUST pick up a copy of the early dismissal in the E office or Welcome Center (the earlier, the better).

2) The student will show their teacher (during the pd. they are leaving) their pass to leave early.

3) At the time of early dismissal, the STUDENT is responsible for leaving the classroom and heading to the welcome center where it is required to sign out.

Email *

Student Name (First and Last) *

Student Grade Level *

9th Grade

10th Grade

11th Grade

12th Grade

Date of Early Dismissal *

Time of Early Dismissal *

Time

Reason for Early Dismissal *

Bereavement

College Tour / College Visit

Community Service

Drivers Ed Class / Drivers Test / In-Cars

Family Emergency

Medical Appointment(Doctor, Dentist, Physical Therapy, etc.)

Pre-approved Vacation

Released by Nurse

School Athletic Contest

Other:

Parent or Guardian Name (First and Last). Typing first and last name serves as an electronic signature. *

Parent or Guardian Phone Number *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of New Albany - Plain Local Schools. Report Abuse

Forms