If you need to change your child’s dismissal plan on any given day from pick-up to bus or bus to pick-up, or after school activity, you may use this form. Please use a separate form for different options per student. After 12:00 pm we will NOT be able to accommodate any changes to your child’s dismissal plan, unless it is an emergency. School Office (440)247-6530. DO NOT USE THIS FORM FOR STUDENT ABSENCES. ABSENCES MUST BE CALLED INTO SCHOOL OFFICE.
Date
*
-
Month
-
Day
Year
Date
Student(s) First & Last Name(s)
*
Grade(s)
*
Kindergarten
1 - First
2 - Second
3 - Third
4 - Fourth
5 - Fifth
6 - Sixth
7 - Seventh
8 - Eighth
Pick-up & After School Options
*
Bus Rider Home
Bus Rider Other Than Home (List
Car Rider
After School Activity (List activity in Notes)
Going Home with (List in Notes)
Early Dismissal (Enter time below)
Appointment Pick-up (Enter time below and if student is returning)
Pick up Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Returning to School After Appointment
Yes
No
Notes (Activity or Address)
Email Address To Send Confirmation
*
example@example.com
Signature
*
Clear
Submit
Should be Empty: