Everett High School Dismissal Form

FILL OUT THE FOLLOWING

Please dismiss (name of student):

At (time):

On (date):

The reason for this dismissal is:

Signed by (parent/guardian):

Phone number where I can be reached to verify the dismissal:

No student will be dismissed unless

• The signer’s name is in our computerized records as the parent or legal guardian.

• The signer answers the phone if a verification call is made.

• The reason for dismissal is clearly stated.

• This form is presented to the proper authority by 7:55 A.M. on the date of the dismissal

*Dismissals may be denied under the regulations stated in the Student Handbook.*

EVERETT HIGH SCHOOL
DISMISSAL VERIFICATION FORM

Student Name: _____________________________

Date Dismissed: ________________ Time Dismissed: _____________

Teacher’s Signature Date Work Complete

Period 1______________ ________________

Period 2______________ ________________

Period 3______________ ________________

Period 4______________ ________________

Academy Assistant Principal’s Approval: _______________________

Once form is complete, return to the Dean for absence from class(s) to be waived.

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