2014/2015 Dear Parent/Guardian,

Dear Parent/Guardian,
In order to facilitate dismissal procedures, please use the form below if your child has a change regarding
dismissal. Please complete all necessary information. If your child is not taking the bus, going to after care,
or is riding the bus and normally does not a written note must be presented to the teacher in the morning.
The office will not take telephone messages unless there is an emergency. If you need additional forms,
there will be copies in the main office, or you can download and print a copy from Ms. Pilger’s web site. The
document will be located under the tab “dismissal forms.”
Thank you for your anticipated cooperation in this matter. If you have any questions and/or concerns, feel
free to contact me at school.
Ms. Pilger
(Please detach and return the bottom half)
Dear Ms. Pilger,
This note can serve as documentation that my child has a change in dismissal on (insert date) ____________________.
Child’s name:_______________________________________
Teacher’s Name:___________________________________
Bus number:________________
__________ Will not be riding the bus home from school. ____________________________________ will pick him/her up.
__________ Will be riding the bus home and not going to After Care.
__________ Will not be going to After Care. ___________________________________will pick him/her up.
Thank you,
Parent/Guardian signature
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