REQUEST FOR FREE PERIOD

REQUEST FOR FREE PERIOD

Community Lunch or Free-period open campus privileges are available to juniors and seniors who are passing all classes, maintaining regular and prompt attendance to school and class, and adhering to the Code of Conduct. These privileges may be suspended or revoked at the discretion of a school administrator based on academic concerns, attendance concerns, or violations of the Code of Conduct.
Please complete this form to provide your permission for your child to leave campus during lunch and/or study hall for the 2026-2027 school year.

Submissions will be reviewed for approval starting 09/28/2026
Student Name

First NameLast Name
Grade
School Counselor
PLEASE CHECK ONE OF THREE OPTIONS BELOW
Parent/Guardian Name

First NameLast Name
Parent Signature
Relationship
Parent/Guardian Email
example@example.com
Request Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: