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Dows Lane Dismissal and Emergency Contact Form
Student: ___________________________________ Teacher: ____________________________ Grade: _____
Address: _______________________________________________________ As of Date:_____________
Parent/ Guardian:
Cell #:
Work #:
Parent/ Guardian:
Cell #:
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.
Monday
Tuesday
Wednesday
Thursday
Friday
Assigned bus home
or
after school buses
Macia (#8), ICC (#9), JCC (#11)
Bus#_____
Bus#____
Bus#____
Bus#____
Bus#____
Pick up
Emergency Contacts who have my permission to pick up my child:
Name:
Cell #:
Name:
Cell #:
Name:
Cell #:
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