1. Parallel Program – Early Dismissal Request START Site: _________________________Site Director: __________________ Student: ____________________________Grade: _________ Parallel Program(s) Activity: ________________________________________________ Dismissal Day(s): ______________Dismissal Time(s): _____ to _____ Returning to START Program: _____ YES _____ NO Returning Time: _____ Notes: __________________________________________________________________ I understand that the staff of the START program is not responsible for my child while he/she is not present at the START program. Parent/Guardian: ____________________Phone___________________________ Permission for START Staff sign-out: (initial) ______Date: _________ Early Dismissal Policy Sacramento START has been made available to your child through the State of California Afterschool Education and Safety (ASES) program funding. As a funding requirement:  Students are expected to attend Sacramento START (5) days per week  Students are expected to attend (3) hours each day Sacramento START encourages students to attend Monday – Friday after school until the conclusion of the program in order to be academically and socially successful. All early dismissals and absences will require a note/phone call from the Parent/Guardian. Sacramento START understands that situations do occur that cause students to need to leave early or miss a day altogether. The bulleted items contain examples of excusable reasons for signing out of START early or missing program: ON or OFF CAMPUS  Tutoring, Homework Clubs  Choir, Band  Sports, Martial Arts  Newspaper, Student Council  Drama, Play rehearsal  Dance, Cheerleading For reasons of early dismissal for PARALLEL PROGRAMS, please complete and return this request to the Site Director. 2013-14 Early Dismissal Policy Parallel Program

2. Sacramento START Program Pass Date: __________ Student:______________________________________ Grade: ______________ Teacher/Staff: ______________________________________ Location: ______________________________________ Reason for Program Pass: ___________________________________________________________ Students must sign-in with START staff for a pass! START: Time Left _________ School: Time Arrived _________ School Staff is asked to escort students to program! School: Time Left _________ START: Time Arrived _________ _________ (initial) Yes, this student was escorted back to program for a safety check-in ! School Staff X___________________________________________ START Staff X__________________________________________ Sacramento START Program Pass Date: __________ Student:______________________________________ Grade: ______________ Teacher/Staff: ______________________________________ Location: ______________________________________ Reason for Program Pass: ___________________________________________________________ Students must sign-in with START staff for a pass! START: Time Left _________ School: Time Arrived _________ School Staff is asked to escort students to program! School: Time Left _________ START: Time Arrived _________ _________ (initial) Yes, this student was escorted back to program for a safety check-in ! School Staff X___________________________________________ START Staff X__________________________________________ Sacramento START Program Pass Date: __________ Student:______________________________________ Grade: ______________ Teacher/Staff: ______________________________________ Location: ______________________________________ Reason for Program Pass: ___________________________________________________________ Students must sign-in with START staff for a pass! START: Time Left _________ School: Time Arrived _________ School Staff is asked to escort students to program! School: Time Left _________ START: Time Arrived _________ _________ (initial) Yes, this student was escorted back to program for a safety check-in ! School Staff X___________________________________________ START Staff X__________________________________________ Sacramento START Program Pass Date: __________ Student:______________________________________ Grade: ______________ Teacher/Staff: ______________________________________ Location: ______________________________________ Reason for Program Pass: ___________________________________________________________ Students must sign-in with START staff for a pass! START: Time Left _________ School: Time Arrived _________ School Staff is asked to escort students to program! School: Time Left _________ START: Time Arrived _________ _________ (initial) Yes, this student was escorted back to program for a safety check-in ! School Staff X___________________________________________ START Staff X__________________________________________ 2013-14

3. STUDENT NAMEMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYCOMMENTS Slash = Student arrived/is here (--) Circle = Student did not show/absent (O) Time Notation= Student arrived, but was late (TIME NOTE) D= Student was dropped from tutoring or START. SITE: PARALLEL PROGRAM ACTIVITY: START STAFF NAME: Students check out of START to go to parallel program Students checked back in to START from parallel program STUDENT NAMEMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYCOMMENTS Time students left for PP: Initials M ___________ __________ T ___________ __________ W ___________ __________ Th __________ __________ F ____________ __________ Time students arrived back form PP: Initials M ___________ __________ T ___________ __________ W ___________ __________ Th __________ __________ F ____________ __________