Fillable Junior and Senior Off Campus Lunch Permission Form

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Junior and Senior Off Campus Lunch Permission Form

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Junior and Senior
Off Campus Lunch Permission Form
2016-2017
Everett High School
Student Name:__________________________________________________________________________
Student ID:__________________ Grade Level:____________ Number of Credits:__________
As the parent/guardian of the student above, I am aware of the “Off Campus” privilege available to my student
per school and district policy. This privilege is only available to 11
th
and 12
th
grade students with 11 or
more credits or more, and only during their lunch period.
By signing this form, I consent to my student leaving campus for his/her lunch and fully understand that the
school will not provide supervision for off-campus, nor will the school be responsible for my student during the
time they are off campus.
I further understand that this is a privilege and conditioned upon the following expectations:
• Mature and responsible conduct while off
campus.
• Respect for the property and personal rights of
others and the community.
• Arriving back on campus in time for class.
• Not encouraging, transporting, or socializing
off campus with students that do not have off
campus permissions.
I agree that should my student act inappropriately while off campus by violating any of the expectations above
or engaging in inappropriate or illegal conduct, that this privilege shall be revoked.
If you have any questions or concerns, please contact Mrs. Kippenhan or your student’s administrator at
425.385.4438.
As the parent/guardian, I understand the expectations of this privilege and judge that he/she can handle it.
______________________ ______________________________________________
Date Signature of parent/guardian
As the student, I understand the expectations of this privilege and agree comply with all of them. I will be
accountable for my actions while off campus.
______________________ ______________________________________________
Date Signature of student
** 9
th
and 10
th
grade students
ARE NOT
eligible for Off
Campus per school policy
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Junior and Senior Off Campus Lunch Permission Form

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Completed 12 November 2020

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