OFF-CAMPUS LUNCH FORM

OFF-CAMPUS LUNCH PARENT PERMISSION FORM

High School Only
Students are responsible for their own actions while they are off-campus. The school provides no supervision of off-campus activities and assumes no liability for any accident or injury that occurs while off-campus.

In order to obtain and retain off-campus lunch privileges, each student:

• Must have a permission form on file.

• Must sign out at the front desk when leaving and sign back in when returning to the campus.

• Must be on time to the class following his/her lunch period. Three (3) tardies to that class may result in the loss of the off-campus lunch privileges.
• Must return to school for the remainder of the school day. Note: If a student becomes ill while off campus, a parent/guardian must call the school office to report the absence. All absences are chargeable absences towards the attendance policy.
• Will not leave food, drink, or litter in the parking lot.
• May not transport any other student.

Failure to abide by any of the above rules will result in loss of off-campus lunch for remainder of quarter, semester, or year.
PARENT:
I, as the parent or legal guardian of    First Name   Last Name   hereby give my permission for my son/daughter to leave the campus of Eastgate Academy during his/her scheduled lunch period. By granting this permission, I understand that my child may walk or drive off-campus during his/her scheduled lunch period. In case of an emergency during lunch the parent must call the school office at that time. I understand there is no school supervision off-campus.

I release Eastgate Academy from all liability during the lunch period when my son/daughter is off-campus.

I understand that permission to leave campus at lunch may be revoked by Eastgate Academy if the behavior of my son/daughter is not satisfactory. I also understand that permission to leave campus may be revoked if tardiness becomes a problem.

I have read and understand the Off-Campus Lunch Terms and Conditions.
Parent/Guardian Name:   First Name   Last Name
Parent/Guardian Signature:   Signature   Date:   Date

STUDENT:
I have read and understand the Off-Campus Lunch Terms and Conditions. I agree to follow the rules and conditions stated therein, and I am aware of the potential consequences should I violate any of those terms or conditions.
Student Name:   First Name   Last Name
Student Signature:   Signature   Date:   Date
Should be Empty:

OFF-CAMPUS LUNCH PARENT PERMISSION FORM