Senior Open Campus Privilege Form
Valid 2018-2019 School Year for Enrolled Seniors Only
Student Last Name *
Your answer
Student First Name *
Your answer
Parent/Guardian Full Name *
Your answer
“Open Campus” is defined as a senior privilege to leave the Mullen campus during lunch and free periods. Be aware that during the student’s exercise of the open campus privilege, the school administration may not know the destination, whereabouts, and/or activity of the student; however, the student is still bound by the rules and regulations pertaining to personal conduct as outlined in the student handbook and will be subject to disciplinary action for violations thereof. *
Only seniors with parental permission may have off-campus lunch and free period privileges. Parental permission forms must be completed prior to privilege being granted. It is the senior’s responsibility to return to school on time when using this privilege. Also, taking any underclassman off campus without permission is a serious offense and will result in suspension, individual loss of open campus privileges, and possible forfeiture of open campus privileges for some or all of the senior class. *
Waiver of Liability: When the student and parent/guardian sign the Open Campus agreement (physically or electronically), they agree to release Mullen High School from any and all liability for a student’s actions during his or her exercise of the open campus privilege. Furthermore, the agreement also releases Mullen High School for any and all liability for personal injury or loss of life while the student is exercising his or her open campus privilege. *
I, (student), have read, understand, and agree to comply with the terms and conditions of the senior open campus privilege. Furthermore, I acknowledge that while exercising my open campus privilege, I am bound by the rules and regulations pertaining to personal conducts as outlined in the student handbook and I realize that violations of the aforementioned rules and regulations will be subject to disciplinary action. By signing this agreement, the student and parents agree to release Mullen High School from any and all liability for a student’s actions during his or her exercise of the open campus privilege. Furthermore, this signed agreement also releases Mullen High School for any personal injury or loss of life while the student is exercising his or her open campus privilege. *
Student Electronic Signature (Full Name) *
Your answer
Student Electronic Signature (Date) *
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I/We, parent(s)/guardian(s), have read, understand and agree to the terms and conditions of the senior open campus privilege and grant our permission for the above named student’s participation therein. *
Parent/Guardian Electronic Signature (Full Name) *
Your answer
Parent/Guardian Electronic Signature (Date) *
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