LCBI Sign Out Form

LCBI Sign Out Form

Please complete this form if your student will be missing academic time and/or needs to be signed out of the dorm.
Student Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I am signing my student out from:
* Please note: If a dorm student is signed out for multiple consecutive days during the school week, we will assume that they will also be absent from academic classes during that time.

Academic Absence (Portion of the Day)
Date of Absence

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Departure Time from School

Hour Minutes

AM/PM Option
Return Time to School

Hour Minutes

AM/PM Option
What is the reason for missing academic time?
Electronic Signature. By typing your name and submitting this form, you are accepting responsibility for your child during the time you have indicated that they will be away from school.
Parent/Guardian Full Name
Electronic Signature. By submitting this form, you are accepting responsibility for your child during the time you have indicated that they will be away from school.

Academic Absence (Full Day)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
What is the reason for missing academic time?
Electronic Signature. By typing your name and submitting this form, you are accepting responsibility for your child during the time you have indicated that they will be away from school.
Parent/Guardian Full Name
Electronic Signature. By submitting this form, you are accepting responsibility for your child during the time you have indicated that they will be away from school.

Academic Absence (Multiple Days in a Row)
LCBI High School is not in a position to either grant or deny permission for any student to miss school for an extended holiday or other absence from class. The decision is the responsibility of the student and parent(s)/guardian(s). Although extended trips can be excellent opportunities, the administrators and teachers discourage family or personal holidays that result in students missing extended periods of school. If such an absence is necessary, the onus is on the student to be responsible for communicating with teachers and catching up with all missed work.
First Day of Planned Absence

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Day of Return to School

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Reason for Absence
Electronic Signature. I have read the information above and understand that my son/daughter will miss classroom instruction and class discussion during his/her absence, which may not be able to be replicated. Furthermore, I understand that the responsibility for missed work rests solely on the student.
Parent/Guardian Full Name
Electronic Signature. I have read the information above and understand that my son/daughter will miss classroom instruction and class discussion during his/her absence, which may not be able to be replicated. Furthermore, I understand that the responsibility for missed work rests solely on the student.

Dorm Sign Out
Please Note:

If a dorm student is signed out for multiple consecutive days during the school week, we will assume that they will also be absent from academic classes during that time.
Departure from Campus

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Departure

Hour Minutes

AM/PM Option
Return to Campus

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Return

Hour Minutes

AM/PM Option
Student will also be missing academic time:
Is Student Going Home?
What is their destination?
List the name of the adult responsible for student while away from campus.
Phone number of the adult responsible for student while away from campus.
Please enter a valid phone number.Format: (000) 000-0000.
Address of where student will be spending their time away from campus.
How will they be travelling to and from campus (their own vehicle, with a friend, etc.)
Comments or additional information:
Electronic Signature. By typing your name and submitting this form you are agreeing to transfer responsibility for your child from LCBI to yourself or the listed receiving adult for the duration of the time indicated they will be away from campus.
Parent/Guardian Full Name
Electronic Signature. By submitting this form you are agreeing to transfer responsibility for your child from LCBI to yourself or the listed receiving adult for the duration of the time indicated they will be away from campus.

Academic Absence