Student/Parent Information/Acknowledgement Form

Student/Parent Information/Acknowledgement Form

Name: ______

LastFirstMiddle

Home Phone: (___) ______

Parents or Guardians ______

Mother’s Email ______

Mother’s Cellular Number ______

Father’s Email ______

Father’s Cellular Number ______

Course Syllabus and Classroom Expectations

I have read, understand,and acknowledge receipt of Course Syllabus and Classroom Expectations. I can contact Ms. Whitehead Coleman at or 770-651-2763 if I have any questions.

Student Signature: ______Date: ______

Parent Signature: ______Date: ______

Class Assignments –Engrade -

I understand that assignments and due dates are posted on Engrade. I can contact Ms. Whitehead Coleman at or 770-651-2763 if I have any questions.

Student Signature: ______Date: ______

Parent Signature: ______Date: ______

Grades – Parent Portal -

I understand that all grades are posted on parent portal. I can contact Ms. Whitehead Coleman at or 770-651-2763 if I have any questions.

Student Signature: ______Date: ______

Parent Signature: ______Date: ______

The Douglas County Board of Education does not discriminate on the basis of sex, race, religion, national origin, disability or age in educational programs or activities, or employment practices.

Media Release

Health Science Students and HOSA Members are active in many community events, and our activities that are frequently published in local newspapers, newsletters, and publications. Students are often photographed, interviewed, and quoted for use in such media. Please contact Ms. Coleman with any questions or concerns.

Student Signature: ______Date: ______

Parent Signature: ______Date: ______

Laboratory Safety Affidavit

Health Science involves frequent hands-on practical sessions. Appropriate safety procedures and techniques will be discussed prior to each activity. Deviance from these procedures at any time will result in automatic exclusion from that practical session, and a written project will be assigned. Additionally, students be held responsible for any broken/missing equipment. Repeat violations will be managed on an individual basis. Student- I agree to follow safety regulations to ensure not only my own safety but also the safety of others. I also agree to follow the general rules of appropriate behavior for a classroom at all times to avoid accidents and to provide a safe learning environment for everyone. I understand that if I do not follow all the rules and safety precautions, I will not be allowed to participate in activities. Parents - No student will be permitted to perform activities unless this acknowledgment is signed by both the student and parent/guardian and is on file with Ms. Coleman. Your signature indicates that you have read the Safety Regulations, reviewed it with your child, and are aware of the measures taken to ensure the safety of your son/daughter.

Student Signature: ______Date: ______

Parent Signature: ______Date: ______

Instructional Media

Health Science uses various videos, DVDs, audio tapes, programs, and similar media that may contain profanity, nudity, and/or gruesome images as a part of the class; some movies may be rated R. While all efforts are made to minimize such material, it can prove extremely useful for addressing some course content (such as legal and ethical violations). Never is such material used in a gratuitous manner. Parents are encouraged to express any concerns with Ms. Coleman in writing.

Student Signature: ______Date: ______

Parent Signature: ______Date: ______

The Douglas County Board of Education does not discriminate on the basis of sex, race, religion, national origin, disability or age in educational programs or activities, or employment practices.