Kellenberg Memorial High School -Early Dismissal Form
Please complete and submit this form to request an early dismissal for your child.  This form may only be completed by the Parent or Guardian of Record.  You will receive an email to confirm receipt of this request.
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Email *
Student First Name: *
Student Last Name: *
Student Homeroom / Cohort (ie. 9A) *
Date for Early Dismissal *
MM
/
DD
/
YYYY
Time for Early Dismissal *
Time
:
Reason for Early Dismissal *
Who Will Meet the Student? (First & Last Name) *
Relationship to Student: *
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