180 Weekend Time Away Form

Student Name*
First Last
Student Grade*
- 6
- 7
- 8
- 9
- 10
- 11
- 12
Gender*
- M
- F
Reason for being excused from 180 Weekend*
Student will be picked up by:*
First Last
Relationship to Student:*
Details:
Please describe the dates and times that your student will be leaving/arriving at 180 Weekend. (Example: Arriving at 11pm on Friday February 15th and staying for the remaining duration of the weekend OR leaving from 2pm-6pm on Saturday afternoon)
Parent Email*
Please provide a parent email for a confirmation and duplicate copy of your Time Away Form.
Parent Printed Name
First Last
Parent Signature*
Date*

602 MINISTRIES