Student Walk Home Agreement

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Important Information:

Parents must fill out a new form for every school year.

Badges will be given to all students in grades 3rd - 6th with a signed form.

Siblings will be added to badges.

Students will not take badges home.

Siblings in the TK - 3rd grades will NOT be released without the 3rd-6th grade sibling.

If the 3rd - 6th grade student is absent, parents must make arrangements to pick up the younger siblings.

If a student loses the walk home badge, the parent/guardian must pick up the student until the pass is reprinted. Please allow 24-48 hours for the badge to be reprinted.

Students are expected to leave campus immediately after dismissal. Students will not be allowed back on campus after being released unless there are special circumstances.
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Helpful tips for parents:

Inform your student(s) about your daily pick up plans in order to avoid confusion.

Contact the office directly if you don’t want your student to walk home on a particular day.

If the pick up arrangements change for the day, call the office no later than 2:00 p.m. so we can ensure they go to the appropriate pick up location.
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Student 1* This field is required.
Student First and Last Name
TK
1
2
3
4
5
6
Grade Level
Allison
Bailey
Banner
Barnes
Contreras
Dominguez
Gallegos
Gascon
Gil
Hassen
Hokanson
Holbrook
Kerklin
Kumamoto
Lyons
Opris
Oropeza
Perez
Quach
Rodriguez
Sanchez
Snyder
Tolsen
Teacher
4
Do you need to add another student?* This field is required.
Yes
No
5
Student 2
Student First and Last Name
TK
1
2
3
4
5
6
Grade Level
Allison
Bailey
Banner
Barnes
Contreras
Dominguez
Gallegos
Gascon
Gil
Hassen
Hokanson
Holbrook
Kerklin
Kumamoto
Lyons
Opris
Oropeza
Perez
Quach
Rodriguez
Sanchez
Snyder
Tolsen
Teacher
6
Do you need to add a third student?
Yes
No
7
Student 3
Student First and Last Name
TK
1
2
3
4
5
6
Grade Level
Allison
Bailey
Banner
Barnes
Contreras, C
Contreras, M
Dominguez
Gallegos
Gascon
Gil
Hokanson
Johnson
Kerklin
Lyons
Opris/Gillman
Oropeza
Perez
Quach
Rhodes
Rodriguez
Sanchez
Snyder
Torres
Teacher
8
Do you need to add a fourth student?
Yes
No
9
Student 4
Student First and Last Name
TK
K
1
2
3
4
5
6
Grade Level
Allison
Bailey
Banner
Barnes
Contreras, C
Contreras, M
Dominguez
Gallegos
Gascon
Gil
Hokanson
Johnson
Kerklin
Lyons
Opris/Gillman
Oropeza
Perez
Quach
Rhodes
Rodriguez
Sanchez
Snyder
Torres
Teacher
10
Parent Info* This field is required.
Parent First and Last Name
Parent Best Contact Number
Alternate Parent Contact Number
Parent Email
11
Emergency Contact Please enter an emergency contact name and number in the event that parents are not able to be reached.
Emergency Contact Name
Emergency Contact Number
12
Alternate Emergency ContactPlease enter a second emergency contact name and number in the event that parents are not able to be reached.
2nd Emergency Contact Name
2nd Emergency Contact Number
13
Parents, by signing below you acknowledge you have read and agree to the provisions stated above. In addition, you give REACH permission to release your student(s) by allowing them to walk off campus on their own. Furthermore, you acknowledge that younger siblings will be released to their older siblings to walk out together upon dismissal. You may revoke this privilege by coming into the office and filling out a revocation of the walk home agreement which states you are no longer allowing your student(s) to walk off campus. Please allow 24-48 hours for the badge to be created.* This field is required.Parent Signature
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