Dismissal Change Request for Trinity Oaks Elementary School

Please fill out this form if you will be changing the way you would like your student dismissed. Form must be submitted before 11am on the day of change. Time submitted exception will be made on inclement weather days. Inclement weather days, change of dismissal will be accepted up until 3pm.

Name of Student Name of Student First Last
Student #
Teacher Name Teacher Name First Last
Name of person requesting the dismissal change Name of person requesting the dismissal change First Last
Relationship to student
Original form of Dismissal
New form of Dismissal

If changing to be a car rider, please remember the car tag must be hanging from your rearview mirror.
Date of Dismissal Change Date of Dismissal Change / MM / DD YYYY