“BE BRAVE, DREAM BIG”
APPLICATION
Terry Parker Off-Campus Lunch Pass
2016-2017 School Year
(Student’s Printed Name) has my permission to check-out of school during lunch.
I, (Parent/Guardian’s Printed Name), understand
that my son/daughter and I are responsible for his/her actions while off campus and in no way will the school or a School Board employee be held responsible for the actions of my child. Abuse of the off-campus lunch privilege or failure to comply with off-campus guidelines may result in revocation of the privilege and/or other disciplinary action.
Parent/ Guardian’s Signature Date
“BE BRAVE, DREAM BIG”
Contact #’s for Verification of Application Home: Work:
Cell:
------
Verified by a Notary:
Notary Seal:
I Authorize My Student To:
o Drive his/herself only
o Drive other off-campus lunch students
with their parents’ permission
o Ride with other off-campus lunch students with their parents’ permission
**Pease check all that apply**
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Notary Name/Signature:
*Off-Campus lunch privileges start September 2016. Applications not verified by a parent/guardian and notary will not be processed. Academic standing is reviewed each nine weeks. Students must maintain an unweighted GPA of 2.5 or higher with no Class 3 or 4 referrals and no multiple class 2 referrals.
**Please read and sign the Off-Campus Lunch Rules on back of this page**
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Off-Campus Lunch Rules
All students who receive the off-campus lunch pass privilege must adhere to the following:
1. Only Junior and Senior students can purchase an off campus lunch pass. Lunch passes are $30 for Senior students and $40 for Junior students. Students with a GPA lower than a 2.5 are NOT eligible to receive a lunch pass. Students may receive the privilege at a reevaluation time in January after midterm grades are finalized. That date is TBA.
2. Due to weather or circumstances deemed necessary by administration, Off-Campus lunch may be cancelled for any day. ALWAYS have lunch money available to purchase lunch in the cafeteria.
3. Students approved for off-campus lunch may not transport other students in their vehicle unless the parent/guardian of both parties has given authorization and been verified through the Terry Parker Off-Campus Lunch Pass form.
4. The driver is responsible for all students in his/her car. If a student has not qualified to be off campus, that student and the driver will receive consequences.
5. A senior with an approved off-campus lunch privilege MUST return to school after lunch. (All check-outs must go through Student Services before, during, and after lunch.)
Your off-campus lunch privileges can be suspended or revoked if you:
a. do not maintain the required GPA each nine weeks.
b. transport or ride with another student who does not have appropriate approval. c. have excessive tardies when returning from off-campus lunch.
d. have disciplinary infractions while on off-campus lunch. e. do not return from off-campus lunch.
I have read, understand, and agree to abide by the Off-Campus Lunch Rules.
“BE BRAVE, DREAM BIG”
Student Signature:
Date:
“BE BRAVE, DREAM BIG”
“BE BRAVE, DREAM BIG”
Parent/Guardian Signature:
Date: