Bathroom Pass

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Hall Pass | Mr. Fields | Room 336
Name: ____________________________________ Period: __________
From this point forward, you all will only have three passes to leave Mr. Fields’ class each month. In the table
below, be sure to put the date, time, and have Mr. Fields sign it before you leave.
o
o
o
o
o
o
o
If you lose this sheet, you will not be given a pass
You may not use a friend’s passes
If you are tardy, you may not use a pass that day
No passes will be given by a substitute teacher
If you forget any materials for class and the bell has already rung, you must use one of these passes to go
and get them
Mr. Fields has the right to deny a pass at any time, for any reason, without explanation
If you have specific bathroom or pass needs, please let me know ASAP, or receive a note from the nurse
permitting such
Month
September
September
September
October
October
October
November
November
November
December
December
Date
Time
Teacher Signature
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