• Please use this form to report temporary changes in dismissal plans to the Hayfield Elementary main office by 2:30 p.m. on the day of the change. Please do NOT submit temporary changes until the day of the needed change. 

  • Requests submitted after 2:30 p.m. will not be fulfilled and students will be sent home via their regular mode of transportation.

  • If the change in transportation involves another student, families of BOTH students must fill out forms.

Thank you! 

This form is to be submitted by the parent/legal guardian only.*
 

Student Information

Student First Name
Student Last Name

Transportation Change Information

Date of Change in Dismissal
Please check this box if you wish to report consecutive temporary dismissal changes.
Regular Bus Number
Regular Bus Stop Location
* Please also contact your child's after school care provider to notify them of the change.
* Please also contact Hayfield SACC to notify them of the change at 703-924-4560.
Bus Number
Bus Stop Location
Name of parent/guardian picking up your child at Kiss & Ride
Name of After School Care Provider
Who will be walking home with your child?
Who is your child going home with?
Please include the student's name, teacher, and mode of transportation.
*The other student's family must also submit this form. 
Who is coming home with your child?
Please include the student's name, teacher, and mode of transportation.
*The other student's family must also submit this form. 
Other - Please describe

Parent/Guardian Contact Information

Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone Number
Parent/Guardian Email Address
Parent/guardian, please use your device to write your signature above.