B Lunch Check-Out Form

If you would like your student to have permission to leave school at the beginning of "B" lunch, which begins at 12:59pm, you must complete this form for us to keep on file. Please reiterate to your child that the expectation is that they leave our campus immediately at 12:59pm. Students & parents will receive an approval email via myStudent. Once this email is received, the student may begin leaving campus for "B" lunch.

Student Number
Student Name Student Name First Last
Grade Level

Grade Level 9th 10th 11th 12th
Parent/Guardian Name (Must match in MyStudent) Parent/Guardian Name (Must match in MyStudent) First Last
Parent/Guardian phone number is required & must match MyStudent. Parent/Guardian phone number is required & must match MyStudent. - ### - ### ####
Parent/Guardian email is required and must match MyStudent.
Parent/Guardian Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.