Change of Dismissal

Student Name Student Name First Last
Student's Grade Level
2nd Student's Name 2nd Student's Name First Last
2nd Student's Grade Level
3rd Student's Name 3rd Student's Name First Last
3rd Student's Grade Level
Beginning Date Beginning Date / MM / DD YYYY
Last Day of Dismissal Change (if only one day put the same date) Last Day of Dismissal Change (if only one day put the same date) / MM / DD YYYY
Check here if this is a permanent change

Check here if this is a permanent change Yes this is a permanent change.
Anything else we need to know.
Student's Normal Dismissal

Student's Normal Dismissal Car Rider Bus Rider Walker/Biker PLACE KidsRKids Van Life Skills Van Keiko Shin Van Wesley Chapel Martial Arts Van Primrose Van Happy Feet Soccer
New Dismissal

New Dismissal Car Rider Bus Rider *Must have bus pass to choose this option* Walker/Biker PLACE KidsRKids Van Life Skills Van Keiko Shin Van Wesley Chapel Martial Arts Van Primrose Van Happy Feet Soccer
Name of Person Requesting Change
Email
Contact Number for Questions Contact Number for Questions - ### - ### ####
No changes are permitted after 3:00pm for same day dismissal change.

No changes are permitted after 3:00pm for same day dismissal change. I am aware that changes made after 3:00pm for same day will not be honored.