BES Change of Dismissal

Please complete this form to notify our school of a change of dismissal for your child(ren). You must complete this form for EACH child. This form must be submitted before 2:30 pm on the day of the dismissal change, in order to be processed.

Today's Date Today's Date / MM / DD YYYY
Student Name
Student Grade Level

Student Grade Level PreK Kindergarten First Grade Second Grade Third Grade Fourth Grade Fifth Grade
Student Number
Teacher Name
Parent/Guardian Full Name
Phone Number
Email address
Normal mode of transportation
Change my child's transportation to:

Change my child's transportation to: Car Rider (I have a car tag). Hiker/Biker 1 (dog park) GREEN GO - this means my child can walk or bike home without an adult. Hiker/Biker 1 (dog park) ORANGE - my child must be released to an adult with a pick up tag to walk/bike home. Hiker/Biker 2 (dog house) GREEN GO - this means my child can walk or bike home without an adult. Hiker Biker 2 (dog house) ORANGE - my child must be released to an adult with a pick up tag to walk/bike home. Bus Rider (this can ONLY be chosen if your child already has a bus pass in myStudent). PLACE
This is a permanent change, and I will also communicate this to my child's teacher.

This is a permanent change, and I will also communicate this to my child's teacher. Yes. No.
If this change is NOT for today, please enter the date for the change, below.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Spam Protection. Please answer this simple question:
2, 4, 8, 10 : which of these is the largest?