High Point Elementary School
Safety Patrol Application
(please print neatly)
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)__________________________________
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)______________________________________