Change of Student Dismissal

Please complete this form when there is a change in your child’s dismissal routine. All changes must be reported by 12:00pm daily with the exception of emergencies.

Change of Student Dismissal
*Student Name: 
(student's first & last name) 

*What is the change in dismissal?: 
(ex. Charlie will be picked up at 3:00pm by his Aunt.) 

*Who is the adult responsible for this change?: 
(Adult student is leaving with or will be under the care of) 
Note: All adults picking up students will need to provide valid picture identification. Students are not permitted to ride home on different buses. Additionally, we may follow up with a phone call to ensure your child's safety.


*Indicates required field.

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