Junior High Lunch Check-Out Week ending 2/4/22
 Students are only allowed to leave with their own parent, grandparent, sibling, or daycare provider, as designated by their primary guardian. Students are expected to eat in the home of one of these individuals.

To sign your child out, please complete this form by 8:30 AM on Monday, January 31st.  This form is for the week of January 31-February 4th

**PLEASE NOTE ON FRIDAY, FEB 4TH SCHOOL WILL DISMISS AT 11:15, THEREFORE NO LUNCH WILL BE SERVED.

If you do not plan to have your child leave for lunch during the upcoming week, you do NOT need to complete the form.

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Student(s) Name: (may include more then one student if in the same family) *
Which days this week will your student be leaving? *
Required
Person Picking Up Student (if walking, type parent's name here) *
Is student allowed to walk home for lunch? *
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