Editing previous response:

Please fix the highlighted areas below before submitting.

Early Dismissal Request Form

Only a parent/guardian can complete this form to notify MSN of a planned early dismissal. Requests should be submitted in advance whenever possible to allow school personnel sufficient time to coordinate dismissal.

Important Information:

Students may only be released to individuals listed as authorized contacts in PowerSchool.
Individuals picking up students must present valid photo identification upon request.
Submission of this form does not automatically authorize a student's release. All requests are subject to school verification and established dismissal procedures.
For unexpected or last-minute dismissal changes, please contact MSN office directly.

Student Information

Student First Name*

Answer required for "Student First Name"

Student Last Name*

Answer required for "Student Last Name"

Student Grade*

Answer required for "Student Grade"

Student ID (if known)

Answer required for "Student ID (if known)"

Parent/Guardian Completing Request Form

Parent/Guardian First Name*

Answer required for "Parent/Guardian First Name"

Parent/Guardian Last Name*

Answer required for "Parent/Guardian Last Name"

Early Dismissal Information

Date of Early Dismissal*

Answer required for "Date of Early Dismissal"

Approximate Pickup Time*

Answer required for "Approximate Pickup Time"

Reason for Early Dismissal*

Answer required for "Reason for Early Dismissal"

Authorized Pickup Information

Full Name of Individual Picking Up Student

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Parent/Guardian Acknowledgment

I understand that my child may only be released to an authorized contact listed in PowerSchool and that the school will follow established identification verification and dismissal procedures.*

Answer required for " I understand that my child may only be released to an authorized contact listed in PowerSchool and that the school will follow established identification verification and dismissal procedures."

Yes