Early Dismissal Form

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Student's First Name

Student's Last Name

Grade

Teacher

Date of Early Dismissal

Time of Dismissal

Will the Student Return to School Later the Same Day?

Yes

No

Parent's First Name

Parent's Last Name

Parent/Guardian Email Address

Parent/Guardian Telephone Number

By submitting this form, you are confirming that you are the parent or legal guardian of the student

Parent/Guardian Signature

Parent/guardian, please use your device to write your signature above.