MIME-Version: 1.0 Content-Location: file:///C:/9E74CAAD/SupervisionForm.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" MINE HILL TOWNSHIP PUBLIC SCHOOL

MINE HILL TOWNSHIP PUBLIC SCHOOL

Request for Supervision at Dismissal from School

For Pupils in Grades Pre-K to 6th

 

Parent/Legal Guardian Name (s):_______________________= ______________________

 

Phone Numbers: Home_______________ Work ______________= __ Cell ____________

 

Child’s Name/Grade: ________________________   Teacher’s Name: _______________

 

Child’s Name/Grade: ________________________   Teacher’s Name: _______________

 

In accordance with Board of Education Policy, I am requesting my child (ren) listed above not be permitted to walk home from s= chool alone unless escorted by a parent or an escort.  Therefore, I am requesting the sch= ool only release my child (ren) listed above to parent/legal guardian or the escorts I designate.  I acknow= ledge I have received and reviewed Board Policy 8601 and understand my obligation= s in authorizing the school district to maintain supervision of my child (ren) a= fter school dismissal including, but not limited to:

 

  2.   I and my designated escort will leave the building promptly upon picking-up the child (ren).

 

  2. Parent/Legal Guardian:________________________     _________________________

    Escorts= :___________________________________       __________________________

    Parents/Legal Guardian Sign= ature:______________________________ Date: _________