Lunch Pass Application

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Senior students are allowed to leave campus for lunch permitting the following requirements:

* Student is currently a 12th grade student
* Student has a GPA of 2.0 or higher
* Student has a 90% attendance rate and has not received a letter of truancy
* Student has acceptable behavior-no disciplinary actions
* Parent/Guardian has read and acknowledged the "Disclaimer" section
* Parent/Guardian has completed and approved the Lunch Pass Application

Email *

Disclaimer

All parents/guardians should be aware of possible issues that may develop as a result of students going off campus for lunch:

* Students return late and may be truant to their class immediately after lunch.
* Students drive or ride with other students and accidents have occurred during lunch.
* Students have been suspended for becoming involved with alcohol and/or drugs off campus during lunch.

We are not saying your student will fall victim to any of the above, but we wish to inform you of the situations that concern school officials. If any of the above mentioned violations occur, the lunch pass will be immediately revoked.

Administration may revoke a lunch pass at any time, at their discretion. Leaving campus for lunch is a privilege. Parents may contact the Assistant Principal's office at any time to request revocation of a lunch pass.

If your student will not be returning to school after lunch (i.e. illness, medical appointment, etc.), a parent MUST notify the Attendance Office in order to have the absence cleared.

Student's Last Name *

Student's First Name *

Student's School ID number

Parent Name *

Parent Contact Number *

Parent Email-must match parent email in Aeries *

Parent/Guardian Permission *

I have read and acknowledge this form. I accept full liability and release Royal High School and the Simi Valley Unified School District of all responsibility during the time my child leaves campus during their lunch period.

A lunch pass is only good for lunch. However, authorization to leave campus is also given for the senior's free period. If a student needs to replace a lunch pass sticker for any reason, a replacement fee will apply.

A copy of your responses will be emailed to the address you provided.

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