______________________________________________________________     ________________________

LAST NAME                                                 FIRST NAME                                   GRADE/TEACHER

 

 

I.                Weather Related Emergency Dismissal

                                                 

                          Go home by normal route: (Circle One)

 

                                bus                   walker                     car

 

                               If no one at home, go to _____________________________________________________

 

                               _________________________________________________________________________

                       

                          Go to the Community After School Program (enrollees only)

 

                                       *Parents to pick-up at earliest possible time

 

                          Go to Daycare _____________________________________________________________

 

II.                            Non-Weather Related Emergency Dismissal (Circle One)

 

                          Go home the following way:

 

                               bus                     walker                     car

 

                                         If no one home, go to __________________________________________________

 

                          If this is not my child’s normal dismissal route, he/she should be instructed to go

                       

                        to: __________________________________________________________________________

 

                                                                       

                                                                                                _________________________________________

                                                                                                            Parent Signature                    Date