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Early Dismissal Request Form

This form is required to be submitted 24 hours before the date of the requested early dismissal. Parent/Guardian(s) who do not submit this form will be required to wait for an undisclosed amount of time while the paper is processed and the student is located. Proper identificaiton will be required upon pick-up to confirm parent/guardian identity.

**Only parent(s), guardian(s), and Emergency contacts on the School Account can pick up a student**

Student drivers are permitted to leave early with signed permission form and a telephone confirmation from the parent/guardian on PowerSchool. Parent/Guardian(s) who wish for their son to drive themselves must indicate so on this form.

**Misspellings or inaccurate information may result a wait for an undisclosed amount of time**

Student's Last Name*

Answer Required

Student's First Name*

Answer Required

Student Grade*

Answer Required

Student ID*

Answer Required

Early Dismissal Date*

Answer Required

Early Dismissal Time*

Answer Required

Who is picking up your son*

Answer Required

My son drives to school and will drive to the appointment

I will come to school and sign my son out of school

A contact on PowerSchool will sign my son out of school

Other:

If indicated other, please provide full legal name, relationship, and phone number

Parent telephone verification is required

Answer Required

Parent / Guardian's Name*

Answer Required

Best Contact Number for Parent/Guardian*

Number Required

Reason for Early Dimissal*

If for a doctors appointment please inlude name and address of doctors office

Answer Required

Proof of Doctor's Appointment

Answer Required

Choose a file or drag it here.

Parent/Guardian Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required