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Permission to Leave Form for Students

This permission to leave form requires a student to get approval from multiple parties to leave campus for a specified time and destination. It outlines 4 steps: 1) Get approval from the Director of Academic Affairs to miss class. 2) Inform teachers and get homework. 3) Inform the dorm parent or Peter Fish. 4) Note any campus job and substitute. It also provides a section for parental permission if traveling with another student.

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toniannsinning
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© Attribution Non-Commercial (BY-NC)
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141 views1 page

Permission to Leave Form for Students

This permission to leave form requires a student to get approval from multiple parties to leave campus for a specified time and destination. It outlines 4 steps: 1) Get approval from the Director of Academic Affairs to miss class. 2) Inform teachers and get homework. 3) Inform the dorm parent or Peter Fish. 4) Note any campus job and substitute. It also provides a section for parental permission if traveling with another student.

Uploaded by

toniannsinning
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

PERMISSION TO LEAVE FORM

Remit to: Director of Residential Life Phone: 518-523-3460 Fax: 518-523-3488

Name Reason I will not be missing any classes. I will be missing classes.

Todays Date

Step 1) I have Kim Dows approval to miss class. _________________________________________________


Kim Dow, Director of Academic Affairs Date

Step 2) I have informed my teacher/s and have completed a Homework Ticket. Step 3) I have informed Peter Fish ______________________________________
Dorm Parent or Peter Fish Date Students Name

Step 4) My campus Job is: ____________________and my Substitute is: ____________________________ Departure Information: Leaving Returning Time am pm am pm Day Date Adult Driver

Destination Information: Responsible Adult Address

Phone #

Permission to Drive/Ride with a NSA Student: NSA boarding/ day students may not travel in automobiles at all during the academic day. No NSA student is to drive or ride with another NSA student without permission from both sets of parents in writing. Additionally, no NSA student may ride with anyone but a faculty/staff member or family member, unless specific written permission is granted by a parent/ guardian for each occasion. I
Parent/Guardian

am writing to give my child


Students name

permission to drive/transport or be driven/transported by


(circle one)

Name

on a trip to

Destination

Parental Permission: Signed:


Parent/ Guardian

Date:

Note: Returning to school is prohibited for the duration of this leave form.

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