REQUEST FOR FREE PERIOD

REQUEST FOR FREE PERIOD

Free period open campus privileges are contingent upon students passing all classes and adhering to the Code of Conduct. These privileges may be rescinded for academic purposes or for violations of the Code of Conduct. This privilege is for Juniors and Seniors over 16 years old only.
Please complete this form to provide your permission for your child to leave campus during lunch and/or study hall for the 2025-2026 school year.

Submissions will be reviewed for approval starting 09/15/2025
Student Name*

First NameLast Name
Grade*

1112
School Counselor*

(Formerly) Robert HeywoodJeffrey Palazzolo
PLEASE CHECK ONE OF THREE OPTIONS BELOW*

I give permission for my child to leave campus for LUNCH ONLY for the2025-2026 school yearI give permission for my child to leave campus for ALL Study Halls andLUNCH for the 2025-2026 school yearI give permission for my child to leave campus for Study Halls checkedbelow for the 2025-2026 school year
Course 1Course 2Course 3Course 4Course 5Course 6Course 7Course 8
Parent/Guardian Name*

First NameLast Name
Parent Signature*

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Relationship*
Parent/Guardian Email*
example@example.com
Request Date*

MonthDayYear
Date
Should be Empty: