AUTHORIZATION FOR STUDENT RELEASE

Marion Independent School District

I hereby authorize that _____________________________ may be picked

Name of student

For early dismissal evacuation by:

Myself only _____________________________________________

Name of parent/legal guardian

Myself or spouse ________________________________________

Name of spouse

Or by _______________________________________________

Name of authorized person

(high school age or older)

___________________ ______________________________

Date Signature of parent/legal guardian

Please be sure to return this form to: Francis Marion Intermediate School

2301 3rd Ave.

Marion, Iowa 52302