Hall Pass Template
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1Hall Pass
This is to allow (Student’s name) _________________________________________________________
Class / Grade ______________________________________________ __________________________
to go to :
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Rest room
Library
Counselor
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Computer room
Medical / First aid facility
Cafeteria
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Multipurpose room
Administrative office
Locker room
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Transport area
Visitors Lounge
Gym
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Other
Specify __________________________________________
Date ______________________________ Time when Student left __________________ AM / PM
Name of Teacher _________________________________ Signature _______________________
Time when student returned ________________________________ AM / PM
Name of Teacher _________________________________ Signature _______________________
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Parent category: Business