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
Student ID#
Teacher's Name
2nd Student's Name 2nd Student's Name First Last
Student ID#
2nd Student's Teacher
3rd Student's Name 3rd Student's Name First Last
Student ID#
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 *Must have bus pass to choose this option Walker/Biker Unescorted(can go without an adult) Walker/Bike Escorted (Met by guardian) Daycare Van *Please indicate name of daycare below*
Daycare Van
Change my child's transportation to

Change my child's transportation to Car Rider Bus Rider *Must have bus pass to choose this option Walker/Biker Unescorted (can go without an adult) Walker/Biker Escorted (met by guardian) Daycare Van *Please indicate name of daycare below
If you are changing your mode of transportation to a daycare van, please indicate the daycare van your child will be riding.
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
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
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