*
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
*
required
Student First Name
*
required
Student Grade*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Kindergarten Teacher
*
required
Please Select…
Webb, Jennifer
Swygard, Kerri
Sexton, Katie
West, Makenna
Shaw, Heather
1st Grade Teacher
*
required
Please Select…
Bruskotter, Sarah
Grock, Amanda
Molony, Amy
Tonges, Jenn
Strozeski, Rachel
2nd Grade Teacher
*
required
Please Select…
Dowd, Susie
Okazaki, Claire
Phillips, Megan
Anderberg, Susan
Webster, Kathryn
3rd Grade Teacher
*
required
Please Select…
Lane, Abi
McGuire, Sara
Rinaker, Nate
Dolezal, Stacey
Churchill, Evan
4th Grade Teacher
*
required
Please Select…
Marr, Ali
Mclaughlin, Cheryl
Sutton, Amanda
Ross, Lee Ann
Allais, Erin
5th Grade Teacher
*
required
Please Select…
Marlin, Julia
Donnelly, Devri
Shah, Ruchi
Wilson, Chrissy
Aivazis, Adriana
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…
car pick up.
going home with a friend in the car pick up area
car pick up by an adult other than the parent/guardian.
going home by bus.
going home with a friend by bus.
going to daycare.
walking home with Parent pick up
walking home alone
walking home with another student
picked up early.
Attending After School Club
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*: