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Home » Parents » Change of Dismissal Form

Change of Dismissal Form

Date request submitted*
MM slash DD slash YYYY
Is this a permanent change?*
- Yes
- No
Permanent change beginning on
MM slash DD slash YYYY
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Student Name (One form per student please)*
Teacher Name*
Home Room*
Parent Name*
Quickest phone # we can reach you at
How do you want your child to be dismissed?*
- car rider with parent
- bus home (assigned bus)
- after school care (CCC)
- after school activity (please specify below)
- car rider with (provide name below)
- bus home with (provide name below)
- early dismissal at (provide time and reason below)
- other (provide details below)
Details for above
CAPTCHA

If you prefer to fill out a printable PDF and scan to the school office email, click here.

St. Mary Parish School | N89W16215 Cleveland Avenue, Menomonee Falls, WI 53051 | Phone: (262) 251-1050