Sharon Elementary School Student Emergency Dismissal Form 2020-2021
Please complete a separate form for each student in the household. Please use LEGAL names on this form.

*If school dismisses due to adverse weather conditions, the After School Enrichment Program will be cancelled as well.
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Student Last Name *
Student First Name *
Student Grade Level *
Student's Classroom Teacher *
Street Address *
Zip Code *
Home Telephone Number *
Mother/Guardian Name *
Mother/Guardian Employer
Mother/Guardian Workplace Address
Mother/Guardian Workplace Phone Number
Mother/Guardian Cell/Home Phone Number *
Mother/Guardian Email Address *
Father/Guardian Name
Father/Guardian Employer
Father/Guardian Workplace Address
Father/Guardian Workplace Phone Number
Father/Guardian Cell/Home Phone Number
Father/Guardian Email Address
In the event of an emergency, inclement weather conditions, or any other condition requiring the termination or early dismissal of school, the Superintendent of Charlotte-Mecklenburg Schools may suspend the operation of the school day. In the event that school is dismissed early for any reason, my child is to: (choose only one option) *
Required
If you chose "Other option", please provide a brief explanation of an alternate dismissal plan for your child.
Emergency Dismissal Contact #1 First and Last Name -                                                   I give permission to the following adult to pick up my child early from school in the case that I or the other parent/guardian cannot be contacted in an emergency situation: *a driver's license or photo ID will be required to pick-up a child from school *
Emergency Dismissal Contact #1 Relationship to Child *
Emergency Dismissal Contact #1 Telephone Number *
Emergency Dismissal Contact #1 Address *
Emergency Dismissal Contact #2 First and Last Name -                                                          I give permission to the following adult to pick up my child early from school in the case that I or the other parent/guardian cannot be contacted in an emergency situation: *a driver's license or photo ID will be required to pick-up a child from school *
Emergency Dismissal Contact #2 Relationship to Child *
Emergency Dismissal Contact #2 Telephone Number *
Emergency Dismissal Contact #2 Address *
Emergency Dismissal Contact #3 First and Last Name -                                                                  I give permission to the following adult to pick up my child early from school in the case that I or the other parent/guardian cannot be contacted in an emergency situation: *a driver's license or photo ID will be required to pick-up a child from school
Emergency Dismissal Contact #3 Relationship to Child
Emergency Dismissal Contact #3 Telephone Number
Emergency Dismissal Contact #3 Address
Does this child have a sibling or siblings at Sharon? *
Required
Please list all sibling first and last names.
Parent/Guardian Signature & date - Include first and last name and today's date *
Submit
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