Permission to Leave Campus 19-20

Jefferson Academy High School

Permission to Leave Campus

Juniors and Seniors Only

Not applicable? Go Back to Main Menu

____________________________________________

I give permission for my student to leave campus for lunch.

I understand that leaving campus for lunch is a privilege which can be revoked by the Jefferson Academy staff at their discretion.

Every week grade reports will be run and any upperclassman that has a 68% or lower in any class will lose their off-campus privileges for the week.

Students who have a grade of F in one or more classes will not be allowed to leave campus.

Student's First Name *

Student's Last Name *

Grade *

Date * +

By typing your name and providing your initials you are providing the electronic representation of your signature and initials for all purposes when used on this document - just the same as pen and paper signature or initials. *

Parent/Guardian's First Name *

Parent/Guardian's Last Name *

Parent/Guardian's Email *

Date * +

By typing your name and providing your initials you are providing the electronic representation of your signature and initials for all purposes when used on this document - just the same as pen and paper signature or initials. *