Extended Ed. Office: (707) 664-2394
EXCEL Special Release/SSU
(Please print, fill out, and return to teacher)
If you work on campus, have unusual pick-up requests, or your child takes the bus, walks home or rides a bicycle (bring a good lock), signing this form releases SSU of any responsibility for your child.
Day Time Phone Number_________________________________
AM class____________________________________PM class___________________________________
Statement of how and where the child is to be released (please write below):