STUDENT PLEDGE. I will do my best to attend AusPrEP every school day as scheduled from June 12 to July 27, 2017, or July 5 to July 27, 2017 for the Pre- Algebra Institute. I have read and understood AusPrEP’s requirements for students, particularly those on attendance, dress code, and student behavior. By signing below, I promise to abide by these policies and all AusPrEP rules. I approve of my child's participation in AusPrEP. I understand this involves a commitment of approximately seven weeks’ attendance. I have read and understand ▇▇▇▇▇▇▇’s requirements for students, in particular that absences must be excused. I will comply with these policies and all AusPrEP rules. ▪ if I am late or leave early more than five times; or ▪ if I am picked up late more than three times. -I understand that, for an absence to be considered “excused”: ▪ the Site Director must approve the absence; ▪ the absence must be approved in advance, except in an emergency; and ▪ AusPrEP must receive a written note signed by a parent/guardian or doctor. -I understand that I must be on time and attend all classes, labs, roll calls, etc. I know I must stay with my assigned group and follow my assigned schedule at all times. -I understand that I must attend the Closing Day Ceremony to complete the AusPrEP program and be eligible for credit. -I agree to follow AusPrEP standards of behavior -- to be courteous, respectful and committed to learning. -I will not bring radios, headphones, laptops, pagers, games, toys, lighters, firecrackers, knives, or weapons of any type to any AusPrEP program. -I will not chew gum or tobacco or have any food or drinks in any of the college classrooms, labs, libraries, etc. I will be responsible for any damage(s) I may cause. -I agree to wear only modest, safe and appropriate clothing. Sandals or open-toed shoes, spandex clothing, tank shirts, slip dresses, sheer clothing, shirts with offensive sayings, and caps are NOT permitted. -I agree to follow all additional rules set by AusPrEP sites. -I understand that AusPrEP has a zero-tolerance policy on a child’s noncompliance with all AusPrEP rules and policies. In the event of a rule/policy violation, the site director may dismiss the child from the program. Some examples of rule violations include: cheating, plagiarism, leaving campus without permission, damaging property, physical violence, setting off fire alarms, or repeated patterns of less serious violations. -I understand that according to the Texas Education Agency, all districts must award one (1) elective for high school graduation for students who successfully complete AusPrEP. -I agree to complete the annual AusPrEP Follow-Up Survey for graduates. (This is a short questionnaire to check on each student’s academic progress. It is used for research on the impact of AusPrEP and for reporting to AusPrEP sponsors.)
Appears in 1 contract
Sources: Parent Consent Form
STUDENT PLEDGE. I will do my best to attend AusPrEP every school day as scheduled from June 12 to July 27, 2017, or July 5 to July 27, 2017 for the Pre- Algebra Institute. I have read and understood AusPrEP’s requirements for students, particularly those on attendance, dress code, and student behavior. By signing below, I promise to abide by these policies and all AusPrEP rules. I approve of my child's participation in AusPrEP. I understand this involves a commitment of approximately seven weeks’ attendance. I have read and understand ▇▇▇▇▇▇▇’s requirements for students, in particular that absences must be excused. I will comply with these policies and all AusPrEP rules. ▪ if Student’s Name Parent/Guardian’s Name Street City State Zip Code Site Assignment ▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇ University AusPrEP Year 2017 The Austin Prefreshman Engineering Program (AusPrEP) is a summer program for middle school and high school students. It is held weekdays from June 12, 2017 to July 27, 2017. It is located at ▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇ University in Austin. Students take courses in math and science; learn about careers in science and engineering; participate in field trips; conduct experiments; and have special activities. Lunch will be provided for all student participants. Parents are responsible for transportation. I am late the Parent/Guardian of the above student. He/she is under eighteen years of age. I am fully competent to sign this Agreement. I give permission for my child to attend AusPrEP. I understand that when my child attends AusPrEP, it is possible that there may be hazards or leave early risks. These could cause illness, personal injury or death. As my child is being allowed to attend AusPrEP, I accept all risk to my child’s health and of his/her injury or death that may result from attending AusPrEP. Daily, I will drop off my child no more than five times; or ▪ if I am 30 minutes before the start of the program (no earlier than 8:00 am) and will assure that my child is picked up late more within 15 minutes of the close of the program (no later than three times. -I understand that, for an absence to be considered “excused”: ▪ the Site Director must approve the absence; ▪ the absence must be approved in advance, except in an emergency; and ▪ AusPrEP must receive a written note signed by a parent/guardian or doctor. -I understand that I must be on time and attend all classes, labs, roll calls, etc3:30 pm). I know release ▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇ University, AusPrEP, and their respective governing boards, officers, employees and representatives, from any and all liability to the student, the student’s personal representatives, estate, heirs, family, and assigns for any and all claims and causes of action for loss of or damage to Participant’s property and for any and all illness or injury to the student, including his/her death, that may result from or occur during the student’s participation in AusPrEP, whether caused by negligence of the University, AusPrEP sites, their governing board, officers, employees, or representatives, or otherwise. I must stay with my assigned group and follow my assigned schedule at all times. -I understand that I must attend the Closing Day Ceremony to complete the AusPrEP program and be eligible for credit. -I also agree to follow AusPrEP standards indemnify and hold harmless ▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇ University, AusPrEP, and their governing board, officers, employees, and representatives from liability for the injury or death of behavior -- any person(s) and damage to be courteousproperty that may result from the student’s actions or omissions while attending AusPrEP. Signature of Parent/Guardian Date Signed Address (If different than Participant’s) City, respectful and committed to learning. -I will not bring radiosState, headphonesZip Signature of Witness Date Signed PARTICIPANT INFORMATION (Please Print Clearly): Last Name First MI Address City State Zip Social Security Number Date of Birth / / Age (Not optional) In case of sudden or serious illness or accident, laptops, pagers, games, toys, lighters, firecrackers, knives▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇ University Health Services, or weapons of any type other Site Health Services professional medical/nursing staff, or other licensed medical personnel may provide necessary emergency medical care to any AusPrEP program(child’s name). -I will not chew gum The listed alternate adult or tobacco or have any food or drinks in any of the college classrooms, labs, libraries, etc. I will be responsible notified immediately. If Health Services staff or other licensed medical personnel are unavailable, AusPrEP staff may provide routine first aid and/or necessary interim emergency care to my child. I understand that ▇▇▇▇▇▇- ▇▇▇▇▇▇▇▇▇ University Health Services and other AusPrEP Site Health Services do not assume any financial or other responsibility. Finally, ▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇ University and AusPrEP are not liable for any damage(s) I may cause. -I agree to wear only modest, safe consequences of the medical care and appropriate clothing. Sandals or open-toed shoes, spandex clothing, tank shirts, slip dresses, sheer clothing, shirts with offensive sayings, and caps are NOT permitted. -I agree to follow all additional rules set by AusPrEP sites. -I understand that AusPrEP has a zero-tolerance policy on a child’s noncompliance with all AusPrEP rules and policies. In the event of a rule/policy violation, the site director may dismiss the child released from the program. Some examples of rule violations include: cheating, plagiarism, leaving campus without permission, damaging property, physical violence, setting off fire alarms, or repeated patterns of less serious violations. -I understand that according any claims related to the Texas Education Agency, all districts must award one medical care. Signature of Parent/Guardian Date Signed Relationship to Participant Parent/Guardian 1 Home Phone Mobile Phone Address Work Phone Parent/Guardian 2 Home Phone Mobile Phone Address Work Phone Alternate Adult (1Emergency Contact) elective for high school graduation for students who successfully complete AusPrEP. -I agree Home Phone Address Work Phone Relationship to complete the annual AusPrEP Follow-Up Survey for graduates. (This is a short questionnaire to check on each student’s academic progress. It is used for research on the impact of AusPrEP and for reporting to AusPrEP sponsors.)child Mobile Phone Family Doctor Telephone Hospital Address Insurance Company Group # Subscriber Food Medicine Plants Animals Dust/Molds Insect Stings Other
Appears in 1 contract
Sources: Parent Consent Form