Student Release Form
This form must be completed and submitted 24 hours in advance before a student is permitted to leave campus. 
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Email *

Student Last Name

 *

Student First Name

 *

Student Preferred Name

 *

Parent/Guardian Name (completing this form)

 *

Parent/Guardian Cell Phone

 *

Parent/Guardian Email

 *

Date of Proposed Release

 *
MM
/
DD
/
YYYY

Day of Proposed Release

 *
MM
/
DD
/
YYYY

Departure Time (EST)

 *
Time
:

Return to Campus Time (EST)

 *
Time
:

Full Name of Adult (age 25+) that will be picking up the student

 *

Adult's relationship to student

 *

Proposed reasoning for release / activity plans

 *
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