Temporary Change of Dismissal Form

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Thank you for informing us about this change in your child's dismissal.

You do not need to confirm receipt of this form. Our office team has on-demand access to the submissions.

Please remember that photo identification is required of anyone picking up a child from school. Parents and legal guardians must give written consent for any other persons to remove their child from school even if that person is listed on the child’s emergency procedure card. Emergency contacts listed on your child’s emergency procedure card are persons you give the school permission to contact if you cannot be reached during the school day and your child needs to be picked up in the event of an unexpected emergency such as an illness or injury.

If someone other than you will be picking up your child, it is best practice to forward to that person the email receipt you will receive soon after completing this form.

NOTE: If the change you are requesting will impact another student or family, it is REQUIRED that both families complete this form. Student safety is our primary concern, and we want to minimize any inconvenience this required procedure may cause.

*Dismissal window closes at 2:30pm *

Email *

Date of Dismissal Change *

YYYY

Student's Last Name *

Student's First Name *

Grade Level of Student *

Child's Teacher *

Regular Dismissal Plan *

Bus

Car Rider

FCCC

After School Care Provider

OTHER

Type of Temporary Change of Dismissal Requested *

Early Dismissal

Bus (Must have indicated during registration and confirmed from Transportation. Please include bus number in the additional details section)

FCCC

Car Rider

Other:

If early dismissal, what time?

Time

Additional Details (ie. Provide Bus #, Pick-Up Person, etc) *

Last Name of Parent/Guardian *

First Name of Parent/Guardian *

Phone Number of Parent/Guardian *

Important Safety Information

Photo identification is required of anyone picking up a child from school. Parents and legal guardians must give written consent for any other persons to remove their child from school even if that person is listed on the child’s emergency procedure card. Emergency contacts listed on your child’s emergency procedure card are persons you give the school permission to contact if you cannot be reached during the school day and your child needs to be picked up in the event of an unexpected emergency such as an illness or injury.

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

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