Emergency Contact and Dismissal Form
Dows Lane Dismissal and Emergency Contact Form
Student: ___________________________________ Teacher: ____________________________ Grade: _____
Address: _______________________________________________________ As of Date:_____________
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Parent/ Guardian: |
Cell #: |
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Work #: |
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Parent/ Guardian: |
Cell #: |
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Work #: |
* Students are unable to switch buses for playdates. Students must ride their assigned bus unless they are going to the Irvington Children's Center(ICC) , Mascia, or JCC.
Please complete the below chart indicating your child’s dismissal plan for the week. Any daily change must be made via a handwritten note to the teacher. We do not accept changes via email.
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
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Assigned bus home or after school buses Macia (#8), ICC (#9), JCC (#11)
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Bus#_____ |
Bus#____ |
Bus#____ |
Bus#____ |
Bus#____ |
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Pick up |
Emergency Contacts who have my permission to pick up my child:
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Name: |
Cell #: |
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Name: |
Cell #: |
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Name: |
Cell #: |