Home
Early Weather Dismissal Form
Prescription Medication Form
05.22.13
[Visitor Login]
Items denoted with a red asterisk
*
are required.
EARLY WEATHER DISMISSAL INFORMATION SHEET
These are the instructions the school will follow if weather dictates early dismissal. Please be as specific as possible.
*
Student Full Name
First Name
M.
Last Name
Teacher Name
*
Home Address
Address 1
Address 2
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
City
State
Zip Code
*
Daytime Phone Number
-
-
(XXX)-XXX-XXXX
*
My child rides Bus # home.
Select an option
None
1
3
11
32
33
37
38
43
*
My child walks home from school.
Select an option
No
Yes
*
On early dismissal my child will:
attend Latchkey
ride the bus
be picked up
walk as usual
use alternate plan
Alternate Plan for early dismissal:
NOTE: By Typing your name in the signature section you are signing this form.
*
Parent/Guardian Signature
First Name
M.
Last Name
Date
Please enter the text
to the right
