Lunch Off-Campus Permission Form

Please take a moment to read the following information regarding off-campus rules and responsibilities.  The staff at Yorktown High School will supervise the open lunch program approved by the Arlington County School Board.  

Seniors who obtain an Off-Campus Lunch Pass may leave the school grounds during their lunch period.  The school is responsible for all students’ behavior and activities during the normal school day from the time a student leaves home until he or she returns home after school (including extracurricular activities). Please review the following code of conduct before filling out the application form. 

  1. Photo ID or appropriate form of identification (StudentVue) required to leave campus at lunchtime. Seniors can pick-up Senior ID cards in the Activities Office.

  2. Seniors will return to campus early enough to ensure that they are not tardy to their next scheduled class. 

  3. Proper conduct and respect for private property, both in the immediate school neighborhood and the community, are necessary. 

  4. Seniors may not take underclass students off campus at lunchtime. 

  5. Seniors may not bring back food for non-12th graders.

Failure to observe the above may result in the revocation of this Senior privilege.  If that student continues to go off campus, disciplinary action will be considered.  

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Email *
First Name
 *
Last Name
 *
Date of Birth
 *
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Student Affirmation: I have read and accept the above rights and responsibilities of having Off-Campus Lunch privileges.  I recognize that this is a Senior privilege and may be revoked for violation of the code of conduct.
By typing my name below, I agree
 *
Parent/Guardian Affirmation: I give permission for my Senior class child to leave the school campus during his/her lunch period.
By typing my name below, I agree
 *
A copy of your responses will be emailed to the address you provided.
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