Unscheduled Early Dismissal Form

Unscheduled Early Dismissal Form
In the event of an unscheduled early dismissal (ie. early closing due to weather, power outages, etc, you will receive an emergency broadcast robo phone call and email informing you of the dismissal and dismissal time. This information will also be posted on our district website www.trivalleycsd.org.

The information you provide below will be used to determine where your child is to go during these situations. Be aware that individual phone calls will not be made to seek out this information, but rather this form
Student Name*
Grade*
Teacher*
In the event of an unscheduled emergency dismissal, my child should:*

Go on their regular buswait to be picked up by the following person
Emergency Pickup Name*
Emergency Pickup Telephone Number*
Parent/Guardian Current phone numbers and the times you are at these numbers:
Home Phone Number*
Please enter a valid phone number.
Times Available on Home Number*
Work Phone Number
Please enter a valid phone number.
Times Available on Work Number
Cell Phone Number
Please enter a valid phone number.
Times Available on Cell Number
Parentguardian Signature*

Clear
Print Name*

First NameLast Name
Should be Empty: