upper school lunch permission 2019/20 sY

This form must be completed for all students attending Summit’s Upper School.

Participation in the independent lunch program is a privilege for academic work and behavior for students who earn a specific number of points prior to lunch. This is an integral part of our motivational program.

If your child has your permission to participate in the independent lunch program and meets the requirements, then lunch privileges will be awarded on a day-to-day basis and may include leaving school property during the lunch period.

Please complete this form and indicate if your child has permission to participate in the Upper School Lunch Program. The program will begin on the second day of school for returning high school students. We will notify incoming students about the program.

Student Name *
Student Name
Parent/Guardian Name *
Parent/Guardian Name
Permission is granted
Additionally, my child may go out to lunch locally.
Permission is NOT granted
Date Submitted
Date Submitted