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Vacation Permission 101509

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					CARLISLE SCHOOL BOARDING UNIT FORM 1A

Vacation permission



A separate form is required for each weekend/overnight request. This permission form must
be faxed/emailed/mailed to the address on page 2 of this form, at least 1 full week in advance
of the scheduled departure date.



Student’s Full Name ______________________________________________________________


Check Vacation Below:
 Labor Day                                         Winter Long Weekend
 October 1                                         Spring Break
 Fall Long Weekend                                 Spring Long Weekend
 Thanksgiving Break                                May 12
 December Holiday Break                            Memorial Day
 MLK Jr. Day


Date leaving school:            _______________ / ____ / _______
                               month                day      year

Date returning to school:       _______________ / ____ / _______
                               month                day      year



Adult responsible for student during the leave:

Name: _________________________________________________________________________

Relationship to student: __________________________________________________________

Address: ______________________________________________________________________

Home Phone: ________________________              Mobile Phone: ________________________

Email address: _________________________________________________________________

Blackberry/Treo information: ______________________________________________________

Other Emergency Contact: ________________________________________________________
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CARLISLE SCHOOL BOARDING UNIT FORM 1A (continued.)


Return form to:   Mr. Jim Heffinger, Dean of Residence   Fax: 276-632-9545
                  217 Carlisle Road, Axton, VA 24054     Phone: 276-632-7288
                  Jheffinger@carlisleschool.org


Name of adult (even if parent or guardian) with whom student will travel to and from school:

Name: _________________________________________________________________________

Relationship to student: __________________________________________________________

Address: ______________________________________________________________________

Home Phone: ________________________                 Mobile Phone: ________________________

 Student will travel alone.

Method of travel from school:
 Car departing at ____ a.m./p.m. with (person driving/accompanying): ____________________
 Plane departing at ____ a.m./p.m. Airline: _________________________ Flight: _________
Flight departure city: Greensboro Roanoke Washington Dulles Raleigh Other: _________
Connecting flights details: __________________________________________________________
 _______________________________________________________________________________
 _______________________________________________________________________________


Method of travel to school:
 Car arriving at ____ a.m./p.m. with (person driving/accompanying): ____________________
 Plane arriving at ____ a.m./p.m. Airline: _________________________ Flight: _________
Flight departure city: Greensboro Roanoke Washington Dulles Raleigh Other: _________
Connecting flights details: __________________________________________________________
 _______________________________________________________________________________
 _______________________________________________________________________________


Parent/Guardian Signature: _______________________________________________________

Transportation companies/taxis may be used to ferry students from school to airports. This will be
done at the expense of the student. The school will make one courtesy run to the Greensboro
airport around major holidays.


Dorm Parent approval: ___________________________________________________________

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