BES Change of Dismissal

Please complete this form to notify our school of a change of dismissal for your child(ren). This form must be submitted before 3:00pm on the day of the dismissal change, in order to be processed.

Today's Date Today's Date / MM / DD YYYY
Student Name
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 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 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 to walk/bike home. Bus Rider (this can ONLY be chosen if your child already has a bus pass) PLACE Other
If "other" is selected, please give description of transportation type:
This is a permanent change.

This is a permanent change. Yes. I would like my child to use this dismissal route everyday. No. This change is only for today.
If today only, please type the date for this change.
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Full Name

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