Change of Dismissal

Please fill out the form to notify school of a change of transportation for your child. This form must be submitted before 1pm (or 11am on Early Release days) on the day of the dismissal change, in order to be processed.

Today's Date Today's Date / MM / DD YYYY
Student Name Student Name First Last
Teacher Name
Student Number
Parent/Guardian Name Parent/Guardian Name First Last
Parent Email
Please provide a phone number in case we need to contact you. Please provide a phone number in case we need to contact you. - ### - ### ####
Normal mode of transportation
Change my child's transportation to:

Change my child's transportation to: School Bus Day Care Van Car Rider PLACE Walker on their Own Front Gate (Blue Shoe) **1st-8th Grade only Walker on their Own Back Gate (Orange Shoe) **1st-8th Grade only Walker with a Parent (Red Shoe) Bike Rider Front Gate **1st-8th Grade only Bike Rider Back Gate **1st-8th Grade only Other Other
This is a permanent change. My child will be using this dismissal route everyday.

This is a permanent change. My child will be using this dismissal route everyday. Yes No, today only
If the change is for a different date than today, please fill in the date for change in transportation.
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