30 Hour Class Lunch Walker Permission Slip

30 Hour Class Lunch Break
Dear Parent or Legal Guardian of 30 Hour Class Student,

We understand that many of our students will be wanting to leave on their lunch break from 12p-1p. They can be picked up by parents to go to lunch or there are places to go to on lunch that are within walking distance. They can also have lunch delivered to the office.

If they do decide to leave, then the procedure is as follows:

1. Parent Permission (by signing and sending in this form prior to class, permission is granted)
2. Each day, students at lunch, who have this form on file, may leave for lunch with a parent or walk to a place to eat.
3. Students will walk directly off ADS premises to lunch. – there is no supervision for them.
4. Once off ADS premises, students are responsible for their own actions. ADS is not responsible for any events the occur during the lunch break from 12p-1p

Completion of this form, prior to the first day of class, is required for your student to leave the office for lunch.
Student Full Name

First NameLast Name
Parent/Guardian Full Name

First NameLast Name
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Select when your student is allowed to walk to get lunch
If you selected "only on certain days" above, please advise below on when your student can walk to get lunch or will be picked up for lunch.
Parent/Guardian Electronic Signature
Date Signed

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

30 Hour Class Lunch Break