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Stratford Academy: Johnson House
719 Birdseye Street
Stratford, CT 06615
Directions/Map arrow

tel: 203.385.4180
fax: 203.385.4185

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Home  ›  General Information  ›  Dismissal Forms

Dismissal Forms

Stratford Academy – Johnson House

719 Birdseye Street

Stratford, CT  06615

(203) 385-4180

                                                                                                                                                           

 

 

Please return this form with your child

 

My Child’s Daily Dismissal Plan for the 2014-2015 School Year (Gr.3-6)

 

 

Child’s Name:

                                                (Please Print)

 

Teacher:

 

 

 

 

 

Check Only One

Option Per Day

 

 

Bus Or Van #

 

YMCA

 

Walker*

 

Monday

 

0

 

0

 

0

 

Tuesday

 

0

 

0

 

0

 

Wednesday

 

0

 

0

 

0

 

Thursday

 

0

 

0

 

0

 

Friday

 

0

 

0

 

0

 

 

*Please list name(s) of person(s) who will be picking up your child each day.

 

 

 

 

 Please check here if you give your child permission to walk home by him/ herself without adult supervision.

 

 

Parent/Guardian Signature:

 

Phone Number:

 

 

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

 

 

Stratford Academy – Johnson House

719 Birdseye Street

Stratford, CT  06615

(203) 385-4180

                                                                                                                                                           

           

 

CHANGE IN DISMISSAL NOTE

 

  Childs Name:                                                                                      Date:

                                                                                                (Please Print)

 

  Teacher:    

 

 

 

 

Today, My child:

 

£ Is a Walker

 

£ Will Be Picked Up In The Car Line

 

£ Is Staying After School For

 

£ Will Be Dismissed At                               AM/PM 

 

£ Will Be Picked Up By:

                                                                    (Name Must Be On School Emergency Form)

 

Phone # of Person Picking Up Student:

 

£   Other:

 

 

 

 

 

Parent/Guardian Signature:

 

Phone Number: