2021-2022 Harrison High School Senior Leave privilege

Senior Leave Form 2021/2022
THIS FORM MUST BE SUBMITTED FOR ANY SENIOR SEEKING LEAVE PRIVILEGE.

Completed forms are due prior to students receiving permission to leave campus.
Last Name of Student *
First Name of Student *
Student E-mail (s) *
separate each additional e-mail with a comma
Student E-mail (s) *
separate each additional e-mail with a comma
Part Time BOCES student? *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone *

Area Code Phone Number
Student Cell Phone *

Area Code Phone Number
Parent Work Phone *

Area Code Phone Number
Parent Cell Phone *

Area Code Phone Number
Parent E-mail (s) *
separate each additional e-mail with a comma
Parent E-mail (s) *
separate each additional e-mail with a comma

PARENT(s) / GUARDIAN(S) PERMISSION TO LEAVE CAMPUS

CAMPUS POLICY: Seniors, with signed parental permission and authorization from the administration, may leave campus during assigned free period(s), lunch period, or in the event of an early dismissal. The administration reserves the right to deny, grant, or withdraw off-campus leave privileges to any senior at any time during the school year.

**Note: Students are prohibited by Board Of Education policy from driving other students to and from BOCES**
I give my permission for my son/daughter, a senior in good standing, to leave campus during his/her assigned free period(s), lunch period or in the event of an early dismissal:
(check ALL that apply) *

driving his/her own car off campus; and/or driven by his/her parent, and/or A SENIOR student who has been granted driving/parking and leave privileges by the school administration
I accept the privilege of being allowed to leave campus during my lunch period for the 2021-22 school year with the understanding that if I violate a school rule, I may, in accordance with the Harrison High School Code of Conduct, lose this privilege for a minimum of 10 days.

Students must abide by the current COVID guidance from the Department of Health and follow any COVID protocols in place by the school.

See Student Handbook online at: http://www.harrisoncsd.org/docs/hhs/studenthandbook.pdf

Additional violations of the Code of Conduct may result in my leave privilege being revoked for the remainder of the school year and may result in my driving/parking privilege being suspended for the first semester of my senior year.

I have read and agree with the above statement.
Parent Name (digital signature) *
Entering your name is your digital signature
Student Name (digital signature) *
Entering your name is your digital signature

DRIVING, PARKING AND OFF-CAMPUS PRIVILEGE

STUDENT / PARENT AGREEMENT
I agree to abide by the Harrison High School Code of Conduct.

Oath/conditions for senior leave privileges

As a Senior of Harrison High School, I agree to the following:
- My actions are a reflection of our school. When leaving campus, I must remember to always be respectful and represent HHS in a positive way.
- I must drive carefully and responsibly both on and off-campus when leaving for lunch periods or frees.
Conditions:
1. Students must abide by the current COVID guidance from the Department of Health and follow any COVID protocols in place by the school.
A failure to meet with any of the above will result in the revocation of all leave privileges.

Student and Parent Acknowledgements
As a Harrison High School senior, I agree to and acknowledge the conditions by which I may exercise my senior leave privilege.
Student Name (digital signature) *
Entering your name is your digital signature
As a parent of a high school senior, I agree to and acknowledge the conditions by which my child may exercise senior leave privileges.
Parent Name (digital signature) *
Entering your name is your digital signature

Thank you for completing this Form

For questions related to this form, please call Larry Mastrota at 914-630-3119 or via e-mail at MastrotaL@harrisoncsd.org
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Senior Leave Form 2021/2022

Student and Parent Acknowledgements

As a Harrison High School senior, I agree to and acknowledge the conditions by which I may exercise my senior leave privilege.

As a parent of a high school senior, I agree to and acknowledge the conditions by which my child may exercise senior leave privileges.

Thank you for completing this Form