Ukiah High SchoolUkiah Unified School District

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Off Campus Lunch Pass

Students in grades 10-12 (with 50+ credits) can obtain a lunch pass application from the office. Parent signature is required.

A lunch pass allows a student to leave campus during lunch to go home or to a business where food is sold. It does not give permission to loiter or congregate near campus. Students must abide by all school rules during lunch, including off-campus.

Misuse of a lunch pass or returning late from lunch more than two times may result in pass cancellation of up to four weeks pending review by an administrator.

Ukiah High School

1000 Low Gap Rd.

Ukiah, Ca. 95482





ID#______________                                  LUNCH PASS APPLICATION                     GRADE________________


NAME :_______________________________________________________________________________                                                 (LAST)                                            (FIRST)


ADDRESS :____________________________________________________________________________


FATHER______________________________________________________________________________                                 (Name)                                                    (Home #)                                                           (Work#)



(Name)                                                    (Home#)                                                            (Work#)

  1. A lunch pass is issued ONLY for going home for lunch, or to a store or restaurant where food is sold.
  2. A lunch pass DOES NOT entitle the holder to loiter or smoke near the campus, or along neighboring streets or sidewalks.
  3. The lunch pass may be REVOKED upon the SECOND incident of a student returning tardy from lunch, at the teacher’s notification.
  4. Parent’s signatures MAY be verified by phone before a lunch pass will be issued.
  5. The lunch pass may be REVOKED as a second consequence for violation of school rules.

___________________                                                                             __________________________________

                 Date                                                                                                            Parent Signature

              ___________________                                                                              _________________________________

                 Date                                                                                                            Verified School Authority