*
Required
Plymouth Elementary School Early Dismissal Form
Student First Name
*
required
Student Last Name
*
required
Grade Level*
Kindergarten
1
2
3
Teacher Name/Room Number
Mrs. DeLaRosa/Room 123
Mrs. Furness/Room 101
Mrs. Handis/Room 121
Mrs. Remaily/Room 102
Mrs. Rodenbaugh (Keller)/Room 119
Mrs. Webster/Room 103
Mrs. Williams/Room 120
Mrs. Youells/Room 104
Teacher Name/Room Number
Mrs. Chubb/Room 206
Mrs. DiRenzo/Room 220
Mrs. Erwin/Room 204
Mrs. Kim/Room 221
Mrs. Pileggi/Room 201
Mrs. Sagel/Room 203
Mrs. Weidamoyer/Room 207
Mrs. Wilson/Room 202
Teacher Name/Room Number
Mrs. Badmann/Room 214
Mrs. Barone/Room 216
Mrs. Diedel/Room 213
Mrs. Grimshaw/Room 209
Mrs. Hartel/Room 208
Mrs. Kelley/Room 210
Mrs. Klein/Room 211
Mrs. Kucher/Room 215
Teacher Name/Room Number
Mrs. Bolasky/Room 108
Mrs. Hendrickson/Room 113
Mrs. Lobos/Room 110
Mrs. Morris/Room 106
Mr. Pezzano/Room 114
Ms. Porter (Smith)/Room 109
Date of Early Dismissal
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required
Time of Early Dismissal
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required
Reason
*
required
Will the student return today?*
Yes
No
Approximate Time
*
required
Parent/Guardian Name
*
required
Parent/Guardian Phone
*
required
NOTE: The parent/guardian email address listed below may be checked against school records.
Please send a confirmation email to the address below*: