SBK8 Change of Dismissal

Please complete this form to notify our school of a change of dismissal for your student. This form must be submitted before 3:00pm on the day of the dismissal change. We only take same day or permanent dismissal changes.

Date: Date: / MM / DD YYYY
Grade Level:

Grade Level: VPK Kindergarten 1st 2nd 3rd 4th 5th
Student Name:
Teacher's Last Name:
Change my child's transportation to:

Change my child's transportation to: Car Rider Hiker/Biker GREEN GO - this means my child can walk or bike home without an adult. Hiker/Biker ORANGE - my child must be released to an adult to walk/bike home. Hiker/Biker ORANGE - my child must be released with their sibling Bus Rider (this can ONLY be chosen if your child already has a bus pass) PLACE
This is a permanent change.

This is a permanent change. Yes. No.
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Full Name

I understand this is a legal representation of my signature.
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