Kick Back Interest Form
This form is for FIVE (Virtual) students only! Students who are receiving instruction in person do NOT need to complete this interest form.
Email *
First Name *
Last Name *
Are you planning to attend the Kick Back? *
I understand that this Kick Back celebration will take place during my FIVE lunch period and I must leave campus immediately after my scheduled time. *
Student Signature *
Parent/Guardian Signature *
Never submit passwords through Google Forms.
This form was created inside of Lexington/Richland School Dist. 5.