Safety Patrol Application

High Point Elementary School

Safety Patrol Application

(please print neatly)

 

Name_____________________________     Address_______________________

 

Phone Number_____________________     City/Zip_______________________

 

Parent E-mail____________________     4th Gr. Teacher__________________

 

How many days of school have you missed during fourth grade?____________

 

How do you get to and from school?____________________________________

 

If you ride the bus, how will you get to and from school when you are on duty?_____________________________________________________________

 

Will you be in the Chinese Class next year?_____________________________

 

Can you arrive at school by 7:25 AM on your duty days?__________________

 

Can you remain on duty until about 2:45 PM on duty days?________________

 

Write a few sentences about your academic performance and your personal behavior.  Are you a hard working and responsible student?  How are your grades?  Are you well-behaved at school, as well as outside of school?  Do you follow directions well?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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I have read the attached letter which explains the general expectations of the High Point Safety Patrol and have discussed them with my child.  I give my consent to have _____________________________ serve as a member of the 2011-2012 High Point Safety Patrol if he/she is accepted as a member.  I also give my permission for my child to attend the after-school meeting on Thursday, May 19 from 2:30 until 3:30 PM.

 

Parent/Guardian Name (please print)__________________________________

 

Parent/Guardian Signature___________________________________________

 

Date___________________

 

Safety Patrol Application Questions

 

Please answer the following questions with your own thoughts, in your own handwriting, using complete sentences.

 

1.     Why do you want to be a member of the High Point Safety Patrol?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

2.     What skills or qualities do you have that would help you be an excellent member of the Safety Patrol and a positive role model for other students?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

3.     What would you do if a student continues to disobey safety rules on the way to or from school when you are on duty?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

I have completed this application on my own, and would like to be considered for a position on the 2011-2012 High Point Safety Patrol.  I understand that this application must be turned in to my classroom teacher no later than Wednesday, May 18 at 2:30 PM.

 

Student’s Name (please print)______________________________________

 

Student’s Signature_______________________________________________

 

Date_____________

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