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Emergency Dismissal Form
Dear Parent, Please complete and return to your child’s
teacher as quickly as possible. Thanks.
Student Name: ________________ Homeroom # ______
In the event of an early dismissal my child has permission
to (please check one):
_____ My child may ride home on their normal bus
_____ My child may ride home on bus # _______ to
Name of person’s home:
____________________________
House address:
_________________________________________
I have discussed with my child a procedure to follow if
they arrive home and no one is home. My child knows
how to get into the house, where to go and who to contact.
Parent or Guardian Signature:
_________________________________________