Which of the following are you reporting?*
Change in Dismissal
On what date?*
If this applies to a range of days, use this for the start date.
If applicable, on what date will this change end?
Time of Early Dismissal*
Please describe the change in dismissal.*
Please note that we may need to follow up with you for further information, and that this form is not a substitute for a bus pass.
Name of person picking up student*
Reason for Absence*
If out for more than 3 days a professional’s note is required.
Reason for tardiness*
If late due to a professional appointment a professional note must be provided.
Reason for early dismissal*
Student First Name*
Student Last Name*
Student's Grade Level*
Adult First Name*
Adult Last Name*
Please send a confirmation email to the address below*: