Teacher:________________________ 2014/2015

__________________________ (Parent please print) (TEACHER-write grade and initial of your last name)

Jane Ball STUDENT DISMISSAL FORM

(Note: One form is required for each student, as every teacher needs their own copy.) GOLD NOTES ARE REQUIRED IF THERE IS A CHANGE IN DAILY DISMISSAL

*****Gold notes MUST be to the office by 12:00 noon****

Student’s name:_________________________________________Today’s (DISMISSAL DATE)ONLY__________________

(PRINT) Last First

From:________________________________ / ____________________________________ relationship:

________________ (Print) (S ignature) ___EARLYDISMISSAL,time______reason_______________by:_________________________relationship______________ ___Will be picked up after school at pick-up doors by____________________________________relationship_________________ ___*Bus HOME (if you don’t normally take your bus home) bus #____________ ___Please send to Boys and Girls Club ___Bike Rider or walking to/from school today ___Grand Tots ___Other:____________________________________________________________________________________________ *STUDENTS ARE NOT PERMITTED TO RIDE A BUS DIFFERENT THAN THEIR OWN ASSIGNED BUS,

PER DISTRICT POLICY.