Lunch Leave Permission Form - Available for Students in Grade 12 only, 2022-2023

Students in grades 9, 10 and 11 do not have a lunch leave option and may not leave school at any time.

Students in grade 12, whose assigned lunch period is 4, 5, 6 or 7, may leave during that period with parental permission. Parental permission indicates that the parent/guardian assumes custody and responsibility for the student during the time he/she is not on school grounds.

In order to receive permission, students must return the Lunch Leave Form and present their ID card to their grade level administrator.  Please note that students will not be permitted to leave campus unless they have a proper school ID.  If your child loses their ID they must obtain a replacement from the Commons Manager, Mr. Slagle.  Lunch leave will be revoked in the event that student attendance is a concern.  The administration reserves the right to revoke the lunch leave permission if necessary.

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Email *
Name of Student (grade 12 only) *
Declaration: I hereby grant my son or daughter, whose name appears below, permission to leave the Northport High School grounds during his or her lunch period.  I understand that by granting such permission for the 2022-2023 school year, I assume responsibility for my son or daughter during the time that he or she is not in attendance in the school. I also understand that the administration reserves the right to revoke the lunch leave permission if necessary. *
Name of Parent/Guardian *
Contact Phone Number (best number to reach parent during the day) *
Student Cell Phone Number *
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