*
Required
Please complete and submit the Change Of Going Home form no later than 12:00 p.m. It is important office and teaching staff have adequate notice to ensure we can support your request. Thank you.
Student Last Name
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required
Student First Name
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required
Student Grade*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Kindergarten Teacher
*
required
Please Select…
Shaw, Heather
Swygard, Kerri
Webb, Jennifer
West, Makenna
1st Grade Teacher
*
required
Please Select…
Bruskotter, Sarah
Grock, Amanda
Molony, Amy
Strozeski, Rachel
Tonges, Jenn
2nd Grade Teacher
*
required
Please Select…
Anderberg, Susan
Dowd, Suzie
Okazaki, Claire
Phillips, Megan
Webster, Kathryn
3rd Grade Teacher
*
required
Please Select…
Lane, Abi
McGuire, Sara
Rinaker, Nate
Sexton, katie
4th Grade Teacher
*
required
Please Select…
Allais, Erin
Dolezal, Stacey
Marr, Ali
Mclaughlin, Cheryl
Ross, Lee Ann
5th Grade Teacher
*
required
Please Select…
Aivazis, Adriana
Donnelly, Devri
Marlin, Julia
Shah, Ruchi
Wilson, Chrissy
Is this a permanent change?*
No
Yes
Which days?*
Monday
Tuesday
Wednesday
Thursday
Friday
Today Only?*
Yes
No
Dates?
*
required
Beginning ?
*
required
(mm/dd/yyyy)
My Child will be
*
required
Please Select…
picked up early.
going home by bus.
car pick up with parent/guardian.
car pick up by an adult other than the parent/guardian.
In Person Pick-up Area - connect with parent/guardian.
In Person Pick-up Area - connect with an adult other than parent/guardian.
going home with a friend in the car pick up area. Friend's Last Name, First Name
going home with a friend by bus. Friend's Last Name, First Name
walking home alone.
walking home with another student
going to Bethany Childcare at Springville.
attending After School club.
car pick up by a company’s van (daycare, club, etc)
First and last name of adult that will connect with student.
When “In Person Pick-up Area - connect with an adult other than parent/guardian” is selected, this field becomes available to fill out.
Name of Company
When “Car pick up by a company’s van (daycare, club, etc)” is selected, this field becomes available to fill out.
What time?
*
required
Only Parents, Legal Guardians and or Emergency Contacts listed in our school records can sign students out of school. Current ID must be presented to office staff. Please note, students will only be retrieved from class once an adult has arrived.
Childcare Name
*
required
Please Select…
Bethany Childcare
Club BV
Kindercare
Sun Academy
YMCA
Other
Name of Childcare
*
required
Childcare Phone Number:
*
required
Friend's Last Name
*
required
Friend's First Name
*
required
Friend's Teacher
*
required
Person picking up student
*
required
Bus Number
*
required
Additional Comments:
Please send a confirmation email to the address below*: