NOTIFICATION FOR AFTER SCHOOL RELEASE
This form must be filled out and brought to the school by you or your child if
he/she is to leave school in a manner other than their normal day to day release
pattern.
I, ___________________________, the parent or legal
guardian of _______________________,
give my permission for the above named student or students to:
Go home with the following adult: ______________________________
Walk home with _____________________________
Ride the bus home with ______________________________
(This requires an office signature as well.)
Walk home alone _________
Other ______________________
Date that student is to use alternate transportation home __________________
Signature of Parent/Guardian _____________________________________
Date note was sent to school _________________________________
Date teacher received this note _______________________________