EmailMe Form - Dismissing Early/Change in Dismissal

Your Name *

First Last

Your Relationship to Student(s) *

Your Email *

Phone *

### - ### - ####

Please select one of the following:

Select the date and time your child will be dismissed early. *

MM / DD / YYYY

HH : MM AM/PM

Name of student(s)

Homeroom Teacher's Email

Name of person picking up Student

First Last

If the person picking up is not on the emergency dismissal form, you must explicitly give permission in the next session.

If applicable, please state name of person picking up student(s)

Signature