2024-2025 Request for Temporary Change of Dismissal

Complete this form PRIOR to 3:15pm if you need to change your child's dismissal. No changes are permitted after 3:15pm!

EARLY RELEASE DAY CHANGES MUST BE SENT IN BY 1:15PM on the day for early release.

**CHANGES SHOULD NOT BE MADE ON A DAILY BASIS**

Student Name Student Name First Last
Teacher's Name
2nd Student's Name 2nd Student's Name First Last
2nd Student's Teacher
3rd Student's Name 3rd Student's Name First Last
3rd Student's Teacher
Beginning Date Beginning Date / MM / DD YYYY
Ending Date Ending Date / MM / DD YYYY
Student's Normal Dismissal

Student's Normal Dismissal Car Rider Bus Rider Walker/Bike Rider Daycare Van PLACE
New Dismissal

New Dismissal Car Rider Bus Rider *Must have bus pass to choose this option Walker/Biker Unescorted(can go without an adult) Walker/Bike Escorted (must have an adult meet them at school to leave- with ID/CarTag) PLACE Daycare Van *Please indicate name of daycare below*
Daycare Van
Name of Person Requesting Change- must be the custodial adult in myStudent
Email of Person Requesting Change
Contact Number for Questions Contact Number for Questions - ### - ### ####
Additional Information
NO CHANGES ARE PERMITTED AFTER 3:15PM FOR THE SAME DAY DISMISSAL CHANGE. (no changes after 1:15pm on Early Release Days)

NO CHANGES ARE PERMITTED AFTER 3:15PM FOR THE SAME DAY DISMISSAL CHANGE. (no changes after 1:15pm on Early Release Days) I AM AWARE THAT CHANGES MADE AFTER 3:15PM (or 1:15pm on ERD) FOR THE SAME DAY WILL NOT BE HONORED
Spam Protection. Please answer this simple question:
What is "eleven" as a number?