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. Please note: YOU MUST SUBMIT A CHANGE FOR EACH DAY, on the day of the change.

Any changes for Early Release Days (October 28, January 27, or February 24) MUST be entered by 12:30 pm on those days.

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.
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.
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