Pendergast Elementary School District
Required Forms Packet
This packet accompanies the Pendergast Elementary School District Student Parent Handbook that was provided to you and your child. For your convenience, the signature pages required for the Handbook are all included in this packet. Please read the entire Handbook. Your signatures in the packet signifies that you have read all of the associated information in the Handbook. The following pages are included: □ Directory Consent/Student Information Release (FERPA) (from p. 2) □ Court Unified Truancy Suppression (C.U.T.S.) Guidelines and Procedures (from p. 7) □ Basic Campus Rules and Student Management (from p. 8 & pp. 11-17) □ District Student Dress Code (from p. 10) □ Extracurricular Activities Fee (from p. 22) □ Tax Credit Program (optional-to be returned to the Business Office) □ Pendergast Nutritional Guidelines (from p. 24-no signature required) □ School Bus Safety Expectations (from p. 29) □ Technology Resources User Agreement (from p. 9) □ School Uniform Policy (may be sent home separately) By returning the entire Required Forms Packet with the appropriate signatures, the school is sure that you have read the Handbook and are aware of student and parent rights and responsibilities. Please return this packet by Friday, August 10, 2007.
Student Name:_____________________________________________ Homeroom Teacher:________________________________________
Please note that schools may need to send home additional forms to help make sure your child has a successful year.
STUDENT INFORMATION RELEASE
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFT Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S/ Department of Education. FERPA information may be found on Page 2 of the Handbook.
As stated in Board Policy J-7082, during the school year, District staff members may compile non-confidential student directory information such as the information below. According to state and federal law, the directory information specified below may be publicly released without permission of parents. However, if you do not want any or all of the identified information about your son/daughter to be released, you may so request by checking off rejected information, signing the form at the bottom of this page, and returning it to the school, within 5 days. If the School District does not receive this notification from you within the prescribed time, it will be assumed that your permission is given to use your son’s/daughter’s directory information that is listed below.
TO: Principal I give my permission for the information listed here to be considered directory information and released by the District without further notification. I have checked information that I DO NOT want provided as directory information. Name ddress A Telephone listing Photograph Date of birth rade level G Dates of attendance Honors and awards received Participation in officially recognized activities and sports
PENDERGAST ELEMENTARY SCHOOL DISTRICT SAFE SCHOOLS DEPARTMENT West Campbell Avenue Phoenix AZ 85037 (623) 772-2356 August 6, 2007 Dear Parent/Guardian, School attendance is not only a good habit, state law requires it. Arizona State Law (15-802.A, 15-803.E) requires every person who has custody of a child between the ages of six and sixteen years shall make sure the child attends school for the full time school is in session unless unable to attend due to illness or another legitimate reason. To encourage and improve school attendance, the Pendergast Elementary School District has implemented a truancy program in partnership with Maricopa County Juvenile Court. This truancy program is called C.U.T.S. (Court Unified Truancy Suppression). We will be tracking attendance very closely. Your child is expected to be at school every day, unless there is an excused reason not to be. An absence is defined as a minimum of one missed class period per day. An unexcused absence will count as a truant day as defined by law. A student is “habitually truant” if he/she has five or more unexcused absences from school. A student that is absent more than ten percent (18 days) of the required number of school days per year is considered to have “excessive absences” whether the absence is excused or unexcused. When a student has five or more unexcused absences or 18 excessive absences (excused OR unexcused), the student can be cited to the CUTS Program through the Juvenile Court. The hearing will be held at a District facility the school campus with representatives from the school and the Juvenile Court. A parent or legal guardian must be present with the student at the time of the hearing. Consequences at the hearing may include the following: required attendance of the parent and the child at an education class (to be held on Saturdays), work hours assigned to the child, counseling, etc. The parent will be assessed a $25 Diversion fee. Failure to complete these consequences may result in suspension of your child’s driver’s license, or inability to get a driver’s license until their 18th birthday and/or formal court proceedings. It is the parent’s/guardian’s responsibility to ensure their child’s attendance in an approved academic setting. If you fail to take the necessary steps to provide your child with appropriate education you may receive a citation. If convicted, it is a Class 3 misdemeanor punishable by jail time and/or fine. The education of your child is extremely important to us. This program is another way that the Pendergast Elementary School District is working with the community to ensure a quality education for all students. If you have any questions or concerns, please feel free to contact the school. Sincerely, Amy Perhamus Amy Perhamus, Director Parent/Guardian Signature _______________________________________________________ Student Signature______________________________________________________________ Date:________________________________________________________________________
Basic Campus Rules
Students and all members of the school community have the right (at school and traveling to and from school) to attend school without fear of harm, threat, intimidation or harassment and that right shall be protected. Therefore, anyone who is subject to student-to-student harassment or misconduct or who knows of the occurrence of such conduct should inform the Administration or Counselor. A substantiated charge against a student shall result in disciplinary action. Pendergast District students, staff, and visitors have the right to safety and respect from others. Therefore, there will be: 1. No possession or use of tobacco, alcohol, illegal substances at school. 2. No profane or foul language or gambling at school. 3. None of the following on campus: o Hair sprays, shaving creams, silly string, spray paint, other aerosols o Electronic devices including cell phones, CD players, electronic games, laser pointers, cameras, tape recorders, radios, etc. These will be confiscated and returned to parents. (The school is not responsible for any item brought to school or confiscated.) o Weapons of any kind including simulated or toy handguns, water guns, water balloons, explosives, firecrackers, matches, lighters o Gum or sunflower seeds. o Stink bombs, snap caps, pop bags, other, or other prank item 4. No disrespectful or threatening comments, inappropriate gestures made toward students, staff members, or visitors. 5. No prescription drugs and over-the-counter medications in the possession of students. These must be kept in the Health Center. 6. No skateboards, roller blades or scooters on campus. 7. No spitting. 8. No gang graffiti and/or gang-style writing on any personal or school property. Any items displaying gang graffiti will be confiscated and returned only to parents.
A more complete list of expectations, guidelines, consequences and definitions can be found on page 8 and pages 11-17 of the Handbook. Please make sure that you and your child read and understand this information in order for your child to have a successful school year.
Bus Code of Conduct Bus transportation is provided for many Pendergast District students daily. Additionally, bus transportation is provided for school activities, such as field trips. This service is a privilege and can be revoked for behavior that endangers the health, safety, and well-being of other students and/or staff members. Information regarding the District Transportation department is found on pages 26-31 of the Handbook. This information includes guidelines for student safety as well as consequences for infractions. Please read this section thoroughly before signing this page. All students waiting for and riding the bus are expected to act responsibly, respectfully, and safely specifically following these guidelines – 1. Ride only the bus assigned to the student and get off the bus at the assigned stop. 2. Follow the Bus Driver and school staff instructions immediately. 3. Sit in assigned seats. Face forward and remain seated while the bus is moving. 4. Keep all carry-on items in your lap. 5. Keep aisle clear and keep all body parts in the bus. 6. Keep hands and feet to yourself. 7. Talk quietly and use appropriate language. 8. No food, gum, and drinks (except water) on buses. Please note that to maintain the safety of your child the driver is not allowed to let a child off the bus at another stop without written authority from the school office. Notes from parents are not acceptable.
Parent/Guardian Signature ______________________________ Date:____________________ Student Signature______________________________________________________________
District Dress Code Pendergast District students are expected to make dress choices that follow these guidelines. Please note that the Principal has the discretion to decide what is disruptive to the educational process, what is appropriate and what is not as current fads and styles are introduced throughout the school year. Shoes must be worn at all times. Tennis shoes must be worn for P.E. classes and intramural sports. Pants, slacks, and jeans must be worn at the waistline. If more than one size too big, pants must be belted at the waist. Belts cannot hang down more than two inches. Undergarments may not be exposed. Pajamas are not acceptable school attire. Hot pants, short shorts, short skirts, and short dresses are NOT allowed. Shirts must be full-length and not show a student’s bare mid-section even when arms are raised. Halter-tops, tank tops, backless tops, low cut tops, and tops with spaghetti straps are not acceptable. Clothing, jewelry, and buttons advertising, promoting, or picturing alcoholic beverages, tobacco, drugs, sexual, or violent behavior are not acceptable. Clothing that has any gang logo, pictures, gang-related language; any gang-related material on it or shows gang affiliation in any manner is prohibited. This includes any claim of gang membership and words of threat or intimidation. Bandanas are prohibited. Sunglasses and gloves are not to be worn in the classroom except with doctor’s orders. No hairnets, bandana, or similar head coverings are to be worn at school. Caps and hats may be worn outside but not inside any school building. Brims are to face forward.
The dress code is in effect for all school-related activities including field trips, dances, and sports activities. Continued infractions of dress code or any rule may and/or will lead to disciplinary actions. Complete District Dress Code Guidelines can be found on page 10 of the Handbook. Some District Schools have adopted a Uniform Policy. If your school has a Uniform Policy, please make sure that you are also aware of these guidelines. Parent/Guardian Signature _______________________________________________________ Student Signature______________________________________________________________ Date:________________________________________________________________________
Student Activities Fees The Pendergast School District believes that extracurricular activities are a very important part of the overall educational process. In order to provide these opportunities equitably to all schools and grade levels, a $2.00 activity fee has been established. This fee will help offset the cost of field trips, tournament fees, referees, sponsor addenda, uniforms, club trips and other items consistent with extracurricular programs. Please complete and return to your child’s school.
Homeroom Teacher ________________________________ Date ______________ Grade ______________________ Student Name _________________________________ Parent Signature _______________________________ Please return with $2.00 to homeroom teacher.
USE OF TECHNOLOGY RESOURCES IN INSTRUCTION TECHNOLOGY RESOURCES USER AGREEMENT Please read this document carefully. When signed, it becomes a binding agreement. Terms and Conditions Acceptable Use. I will use the technology resources to support personal educational objectives within the educational goals and objectives of the School District. Inappropriate use may result in cancellation in use of technology resources and/or appropriate disciplinary action. Technology resources covered by this Agreement include commercial, governmental and private telecommunications-accessible networks (such as the Internet), local networks, databases, and any computer-accessible sources of communication or information, whether from or to file servers, faxes, hard drives, tapes, compact disks, floppy disks, or other electronic storage or retrieval means. Services. The District specifically denies any responsibility for accuracy of information. While the District will make an effort to ensure access to proper materials, the use has the ultimate responsibility for how technology resources are used and bears the risk of reliance on the information obtained. Personal Responsibility. I will report any misuse of technology resources to a parent, teacher, or the system administrator, as appropriate. I will abide by District policies and regulations by using technology resources within the following parameters: I agree to: Use the technology resources for educational purposes only. I understand that use of technology resources for religious or partisan political purposes is prohibited by Arizona and District policy. Obtain permission from my teacher before sending or receiving e-mail outside of the District network.
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Abide by the District’s Student Conduct Policy Keep my personal computer file folder clean and orderly and erase files that I have downloaded onto District equipment as soon as I am finished using them.
I agree not to: Submit, publish, display or retrieve any defamatory, abusive, pornographic, obscene, profane, sexually-oriented, adult-oriented, excessively-violent, threatening, ethnically or racially offensive or illegal materials. Submit or publish material that is known to be false or inaccurate. Access “chatrooms” using District equipment. Reveal my own or any other student’s or staff member’s full name, school, home address, home phone number, use passwords, or social security number on email, the Internet or on-line bulletin boards. Use technology resources for commercial purposes. Use technology resources to access any account in any bank, credit union, or other financial institution. Use technology resources to place any orders for goods or services for any person. I understand that I will solely be responsible for any expenses incurred by orders of goods or services in violation of Policy IJNB and its regulations. Use technology resources in any way that would disrupt the use of the network by others. This would include vandalizing or trespassing in the data of another user and the uploading or creation of computer viruses. Attempt to harm, modify, or destroy any District or other software or records or interfere with the security system. Use another person’s password or post anonymous messages.
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I understand and agree that the District may, in its sole discretion, monitor all student e-mail, folders and material places on District equipment. I understand and agree that I may have no exception of privacy while using technology resources made available in any manner by the District. I HAVE READ AND AGREE TO ABIDE BY THE DISTRICT POLICY AND REGULATIONS ON THE APPROPRIATE USE OF TECHNOLOGY RESOURCES AS INCORPORATED HEREIN BY REFERENCE. I UNDERSTAND THAT ANY VIOLATION OF THE ABOVE TERMS AND CONDITIONS MAY RESULT IN DISCIPLINARY ACTION AND/OR THE REVOCATION OF MY USE OF INFORMATION SERVICES. Student Name ________________________________________________________________ Signature ___________________________________________ Date ___________________
School ______________________________________________ Grade __________________ The student must also have the signature of a parent or guardian who has read and will agree to the terms of this agreement. Parent or Guardian Cosigner: Please sign indicating either acceptance of the terms of this agreement or refusal to apply. As the parent or guardian of the above student, I have read this agreement. I understand that it is impossible for the Pendergast Elementary School District to restrict access to all inappropriate offensive or controversial materials, and I will not hold the Pendergast Elementary School District, its Governing Board or employees responsible for materials acquired by my student through the use of the technology resources furnished by or through the District. I also agree to report any misuse of technology resources to a school district administrator. Misuse may come in many forms, but can be viewed as any material or messages sent or received that indicate or suggest pornography, unethical or illegal solicitation, racism, sexism, inappropriate language, student exploitation by other students or third parties and other issues described in the agreement. Parent Name (print) ____________________________________________________________ Signature ________________________________________ Date ___________________ OR As the parent or guardian of this student, I have read this agreement and understand it. I HAVE CHOSEN NOT TO APPLY FOR STUDENT ACCESS TO TECHNOLOGY AT THIS TIME. I also understand that I may change my mind at any point during the school year and request a new application form. Parent Name (print) ____________________________________________________________ Signature ________________________________________ Date ___________________ Page 3 of 3
TAX CREDIT PROGRAM In 1999 the Arizona State Legislature passed a bill allowing taxpayers to contribute up to $200 (up to $400 for joint filers) per calendar year to a public school, and receive a state income tax credit for the full amount. It is not a requirement that the taxpayer have a child enrolled in public school. The tax credit is available to all taxpayers and goes directly to the school you choose. To claim the tax credit, taxpayers must contribute to an “Extracurricular Activity” such as, sports, band, choir, drama, music, field trips and tutoring. You may designate a specific activity for your contribution, or ask that it be credited to the “general extracurricular fund” at your school. You may also split your contribution between two or more schools. Please consult with your personal tax preparer to determine the application of this credit. You may use the bottom of this page to accompany your donation. Count me in! Please apply the enclosed contribution of $_____________ to Academic and Extra-curricular Activity Programs at _____________________________________ School. Choose one: Athletics Fine Arts Extracurricular Mail to: Tammy Blanchard Business Office Pendergast School Dist. 3802 N. 91st Avenue Phoenix, Arizona 85037
Name: _______________________________ Address: _____________________________ _____________________________________ Social Security# ________________________ Phone#: ______________________________