Weekend Leave Request Form

Parents/guardians may use this form to give overnight permission to a student. You can:

            1) E-mail the form online; click "Submit Now" button to send.
            2) Print and fax (804) 443-3069 to Keith Krusz, Dean for School Life.
            3) Print and mail to Keith Krusz, SMS, PO Box 158, Tappahannock VA 22560.

      Use TAB to move between fields. Do NOT use ENTER until you have completed the form!
      If you click ENTER by accident, just click BACK to goback to the form in progress.

 

  
STUDENT / PARENTAL   INFORMATION
Student's Name:
For the Weekend of: Until:
Parent/Guardian Name: Contact Phone #:
Contact E-mail: Verify E-mail:
Overnight Address:
Host Phone #: Host/Hostess:
TRANSPORTATION   INFORMATION
Departure Return
Date and Time: Date and Time:
Car (driver name): Car (driver name):
Train:
train # / station / time 		Train:
train # / station / time
Plane:
airport / airline / flt. # 		Plane:
airport / airline / flt. #
STOP - Section below to be handled by The School Life Office
Advisor Signature   Final Approval  
 


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