Los Angeles College Prep Academy

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Dismissal Authorization Form

Student Name*

Answer Required

At dismissal time, I authorize my child to: *

Answer Required

Walk

Take the bus

Be home without the direct supervision of an adult

Other:

I certify that the above is truthful and if circumstances change I will resubmit this form.*

Answer Required

Yes

Parent or Guardian Full Name:*

Answer Required

Date: *

Answer Required