Change of Dismissal

Student Name Student Name First Last
2nd Student's Name 2nd Student's Name First Last
Student's AFTERNOON Teacher (KG & 1st have same teacher all day)
2nd Student's AFTERNOON Teacher (KG & 1st have same teacher all day)
3rd Student's Name 3rd Student's Name First Last
3rd Student's AFTERNOON Teacher (KG & 1st have same teacher all day)
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
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
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.