Off Campus Lunch Permission Form

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Student First Name *

Student Last Name *

Student Grade *

Student ID *

Agreement

Please mark yes to acknowledge that you understand and agree to abide by the rules set forth for students to have off campus privileges.

I understand that 11th and 12th grade students are allowed to leave campus for lunch if they have permission from a parent *

YES

I understand that parents are responsible for the health and well being of students when they are off campus. I further understand that there will be no transportation provided at that time. *

YES

Off campus lunch is a privilege that the Board of Education has agreed to support, as long as students are responsible and return to their after-lunch classes on time. I understand that Sand Creek High School can revoke this privilege because of behavior on/off campus, because of excess after-lunch tardies, or because of failing grades. *

YES

As the parent/guardian, I also understand that I can request that this privilege can be revoked. If I decide to revoke my student(s) off campus privileges, I understand that I must notify the school (Tiffany Stewart at 495-1172) *

YES

Parents

My electronic signature indicates that I am giving permission for my student to leave campus during lunch for the 2021-2022 school year.

Students

My electronic signature indicates that I agree to follow all Sand Creek behavior policies and off campus lunch rules.

Parent Electronic Signature: Please type your full name. *

Parent Email: Please list an email to verify permission (if needed) *

Student Electronic Signature: Please type your full name. *

Student Email: Please list your d49 email here so that we may contact you if needed. *

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