* Required

Student ID# :

Student First Name*required

Student Last Name*required

Student Grade*

Kindergarten  1st Grade  2nd Grade  3rd Grade  4th Grade  5th Grade 

Kindergarten Teacher*required

Please Select…Carol, AnnaHiersche, JanaeMartinez, StephanieOrtega, MeghanRosenberger, Celena

1st Grade Teacher*required

Please Select…Bird, CourtneyGettling, KatieKeller, ChristenaLeahy, MeaghanSchroeder, Ashley

2nd Grade Teacher*required

Please Select…Dahlen, DrewDewater, EmilyFowles, AmyHang, DanielleMessina, SandraRoot, Stacie

3rd Grade Teacher*required

Please Select…Duckart, NicholasGretz, KenLeggett, KristiPalmer, MaireadRice, KatieSibelman, Aubrey

4th Grade Teacher*required

Please Select…Bailey, LindseyBergerson, KatieGlem, TamaraHeniff, NicoleLewers, TeresaTanksley, Robyn

5th Grade Teacher*required

Please Select…Curl, Bettina(Duitsman) Galluzzo, AbbyEvans, ChelseyIrwin, MarkPotocki, LucyWolfsehr, Margot

Is this a permanent change?*

Yes  No 

Which days?*

Monday  Tuesday  Wednesday  Thursday  Friday 

Today only?*

Yes  No 

Date?*required (mm/dd/yyyy)

Dates?*required

My student will be*required

Please Select…biking.going home by bus.bus w/Friend: going home with a friend by bus.car pick up.car w/Friend: going home with a friend in the car pick up areacar pick up by an adult other than the parent/guardian.going to daycare.walking-Playground Walker.walking- Ridgeline Walker.walking w/Friend: walking home with a friend.

Childcare Name*required

Please Select…ArtworldBethany ChildcareGoodtime ChineseKindercareOther

Name of Childcare*required

Friend's Last Name*required

Friend's First Name*required

Friend's teacher?*required

person picking up student*required

Bus Number*required

Additional Comments

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