Whitehall Elementary Early Dismissal Form

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

Please fill this form out in completion to ensure that our office receives documentation of a planned Early Dismissal for your child. Thank you in advance for your cooperation! If you have any changes to made once this form is submitted, please contact our front office at (412) 885-7525.

Date of Early Dismissal request *

YYYY

Time of Early Dismissal *

Time

Last Name of student being dismissed *

First Name of student being dismissed *

Child's Homeroom Teacher *

Name of individual picking student up. *

Reason for Early Dismissal Request *

Medical Appointment

Family Emergency

After School Committment

Other

Required

Is the student returning to school? *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Baldwin-Whitehall School District. Report Abuse

Forms