Dows Lane Dismissal and Emergency Contact Form  

Student: ___________________________________ Teacher: ____________________________ Grade: _____

Address: _______________________________________________________    As of Date:_____________

DISMISSAL

• Any dismissal change must be made via a paper note to the teacher. We can not accept emails. In an emergency, please call the office. Students are unable to switch buses for playdates.

Please add a bus # or check the box to indicate your child’s dismissal plans:

EMERGENCY CONTACTS who have my permission to pick up my child: