Daily Dismissal Change Form

Daily Dismissal Change Form

Please complete this form and submit before 2:00 p.m. if you need to make a change to your child's dismissal plan for the day. Changes can no longer be made after 2:00 unless it is a true emergency. Please submit separate forms for each child.
This form is now closed and currently unavailable to accept new dismissal change requests. New requests may be submitted after 3:45pm today.

In the event of an emergency, please contact the Wentworth school office
Student Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Email
example@example.com
Contact Phone Number
Please enter a valid phone number.
Date

MonthDayYear
Date
Date of Dismissal Change*

MonthDayYear
Date
Teacher's Name*
Please select your student's Teacher from dropdown
Dismissal Change Reason*
Please select one of options from the dropdown menu
Early Dismissal for Appointment

We do not call your child until you arrive. Please allow time for your child to transition from their class to the front office.
Time of Dismissal *

Hours: Minutes Minutes

AM/PM Option
Bus Rider

If other than your child's assigned bus, you must contact the bus department at 207-730-4145 for approval
Bus Number*
Car Rider
Name of Person Picking up Student*

First NameLast Name
Car Pooler

Each student's parent in this car pool MUST complete their child's form
Name of Person Picking up Student*

First NameLast Name
Current Time

Hour Minutes
Should be Empty: