West Side Middle School

West Side Middle School Hempstead House Behavior Contract & Permission Slip

Where: Hempstead House, New London, CT When: Monday, April 11, 2016

Time: 9:45AM-12:30PM Cost: Free Grade/Team: 8th Grade Black Team

In order to earn the privilege of attending the Hempstead House field trip, you must prove yourself able to follow school and teacher rules. Your teachers will also consider how you have conducted yourself as a student this year when determining who has earned the privilege of participating. Failure to follow school and classroom rules may result in exclusion from this field trip.

Students MAY be ruled ineligible for Hempstead House field trip if they have:

- Received any out-of-school, or an in-school suspensions; - Multiple office referrals or other behavior issues; - Received 3 or more detentions for misbehavior; - Misbehavior on ANY previous trips.

The faculty reserves the right to allow or disallow participation for students whose past record of behavior raises concerns.

This form must be signed by both the student and the parent/guardian in order for the student to be eligible for the Hempstead House field trip.

Please note that this Behavior Contract will take effect on March 21, 2016. Please Note: Not signing this contract does not delay the start of the Behavior contract.

We will be eating lunch upon return to school.

If there are any questions or concerns, please contact either Mr. Ilvento ([email protected]) or Ms. Quashnie ([email protected] ) or call West Side Middle School (860-449-5630).

Please cut & return bottom portion to school ------

I give permission for my child ______to attend the field trip to Hempstead House on April 11, 2016 from 9:45am-12:30pm. I understand that students will be traveling by school bus.

I agree to the rules and regulations of the Hempstead House field trip. I understand that the Groton Public Schools, West Side Middle School, or any chaperones on the trip are not responsible for any personal items that are brought on the trip.

Student Signature:______Parent/Guardian Printed Name:______

Parent/Guardian Signature:______Parent/Guardian Phone Number:______