Plymouth Elementary School Dismissal Change Form

Student First Namerequired

Student Last Namerequired

Grade Levelrequired

Kindergarten

1

2

3

Dates of Changerequired

Student Will Be Changing To (choose one):required

Walker (Front Door)

Walker (Back Door)

Carline pick up by parent/guardian

Carline pick-up by other adult

Taking assigned bus home

Attending Wonderspring

Taking van to childcare, religious school, etc.

Other

Please be specific.required

Name of Adult Picking up Studentrequired

First and last name. Must be listed in PowerSchool and bring identification.

Student's Bus Numberrequired

Parent/Guardian Namerequired

Parent/Guardian Email required

NOTE: The parent/guardian email address may be checked against school records.

Today's Daterequired

Must contain a date in M/D/YYYY format

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