Temporary Change in Dismissal Form You must have JavaScript enabled to use this form. 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 Information Student First Name Student First Name Student Last Name Student Last Name Teacher Name - Select -BrownDavisElmardiFinkeForniliGrayGreenHendersonJeffriesJohnsonLionatoMarkonMcLaren-WoodMcMullinMerrelMeshankoMichalik-GiacobbiNerswickRodriguezRussellSmithStricklandTaylorVargasYangZehr Grade Level - Select -Kindergarten123456 Transportation Change Information Transportation Change Information Date of Change in Dismissal Date of Change in Dismissal Consecutive Days? Please check this box if you wish to report consecutive temporary dismissal changes. Consecutive Dates How does your child regularly go home? - Select -BusKiss & RideWalkAfter School Care ProviderSACC Bus Number Regular Bus Number Bus Stop Location Regular Bus Stop Location * Please also contact your child's after school care provider to notify them of the change. * Please also contact your child's after school care provider to notify them of the change. SACC 2 * Please also contact Hayfield SACC to notify them of the change at 703-924-4560. Select Transportation Change - Select -BusKiss & RideWalkAfter School Care ProviderSACCGo home with another studentBring another student homeOther Bus Number Bus Number Bus Stop Location Bus Stop Location Name of parent/guardian picking up your child at Kiss & Ride Name of parent/guardian picking up your child at Kiss & Ride Name of After School Care Provider Name of After School Care Provider Who will be walking home with your child? Who will be walking home with your child? Who is your child going home with? 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 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? Who is coming home with your child? Please include 2 Please include the student's name, teacher, and mode of transportation. *The other student's family must also submit this form. Other Other - Please describe Parent/Guardian Contact Information Parent/Guardian Contact Information Parent/Guardian First Name Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian Last Name Parent/Guardian Phone Number Parent/Guardian Phone Number Parent/Guardian Email Address Parent/Guardian Email Address By submitting this form, you are confirming that you are the parent or legal guardian of the student listed above. Parent/Guardian Signature Parent/guardian, please use your device to write your signature above. Leave this field blank Learn more about transportation at Hayfield ES
