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Lake Hall Pass
This form is designed to keep your teacher, Lake Intermediate Administration, and your family informed about your use of class time. You MUST ask permission to leave class. This form needs to be filled out when you leave and return to the classroom.
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* Indicates required question
First name
*
Your answer
Last name
*
Your answer
Grade Level
*
7th Grade
8th Grade
Current Classroom
*
Choose
11
12
13
14
15
16
17
18
19
21
22
31
33
34
35
36
43
45
PE - Milledge
PE - Vo
Period
*
Choose
Period 1
Period 2
Period 3
Period 4
Period 5
Period 6
What are you doing?
*
I am checking out to leave room __ to go to (select reason below).
I am checking in to return to room __ , I was at (select reason below).
Select your reason for leaving or returning.
*
If it is not listed, enter your reason in the "other" field.
Restroom
Nurse
School counselor
School administrator
Room 11
Room 14
Front office
Other:
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