student handbook - mapleton · august 13-17 week of welcome get to know you activities, advisory...
TRANSCRIPT
1
Big Picture College and Career
Academy
Student
Handbook
2018-2019
“One student at a time”
2
Welcome to Big Picture College and Career Academy
Explore • Engage • Empower
BPCCA’s mission is to guide students to explore their personal interests and
passions through engaging, authentic, and rigorous experiences to create life-
long learners empowered to succeed in their chosen career paths.
Big Picture Design—transforming education, one student at a time
When you learn about what you’re interested in, you learn faster and deeper
When you’re deeply known by multiple adults, you have better outcomes
When you connect with experts and do real work in the real world, you become
better prepared for life after school.
When you make a plan that reflects your interests and where you want to go, you
will confidently know what’s ahead
This handbook has been developed as a guide to support students and their parents/
guardians with BPCCA’s approach to learning and what’s ahead this school year.
3
Table of Contents
A. Staff Directory—Get to know us! B. Calendar and Schedule C. Advisory D. Learning Plans E. Competencies and Credits F. Projects G. Internships H. Exhibitions I. Concurrent Enrollment
Contact Information
7350 North Broadway Denver, CO 80221
School Telephone: 303-853-1690 Attendance Line: 303-853-1688
Fax: 303-853-1689
4
Big Picture College and Career Academy
Important Information School Telephone: 303-853-1690 Attendance Line: 303-853-1690
Fax: 303-853-1689
Allison Lusero Hoffman Director x1691 [email protected]
Anna Flores Secretary x1690 [email protected]
Irma Casas Office Clerk x1690 [email protected]
Myda Hernandez Health Para x1683 [email protected]
Jen Olsen (Phil Runnings) 401, English x1698 [email protected]
Julie Larsen (Liang Chen) 401, Math/Science x1684 [email protected]
Carl Kirk 301, English x3080 [email protected]
Jenna Nikkel 301, Spanish x3077 [email protected]
Bradley Haley 301, Math/Science x1687 [email protected]
Adrienne Barlow 201, Social Studies x3083 [email protected]
Lisa Dudgeon 201, Science x1697 [email protected]
Hannah McLendon 201, Math x1685 [email protected]
Austin Pacharz 101, Math x3081 [email protected]
Amy Werpy (Ryan Paul) 101, Science x1686 [email protected]
Betsy Jeanotte 101, Social Studies x1696 [email protected]
Walter Masten Life Skills/Advisor x3076 [email protected]
Janine Fugere Life Skills/Advisor x3078 [email protected]
Dawn Chastain Special Education x3082 [email protected]
Monica Johnson PSOC/LTI Coordinator x1693 [email protected]
Jacilyn Berryman Health Counselor x3079 [email protected]
Cassie Gallegos Social Worker x1699 [email protected]
Cindy Lewis Instructional Guide x1694 [email protected]
Melanie Warning Community Reach Therapist x1981 [email protected]
Mary Cariens Life Skills Para [email protected]
Inoel Melgar Life Skills Para [email protected]
Isaac Mares-Solano Life Skills Para [email protected]
5
Year At-a-Glance
Quarter 1
August 13-17 Week of Welcome Get to know you activities, advisory intro, handbook, nuts and bolts
August 20-24 Discover and Explore Normal daily schedule, Interviews and job shadows, 101 LTI Boot Camp
August 27-Sept 7 Learning Plan Meetings—parent/guardian mtgs to develop Learning Plan Normal daily schedule
Sept 10-Oct 5 Design and Experiment Normal daily schedule, Learning Plans guide learning
Oct 8-Oct 9 Exhibition, portfolio and competency preparation
Oct 10-Oct 12 Portfolio Exhibitions!
Quarter 2
Oct 15-Oct 31 Learning Plan Meeting—parent/guardian mtgs to update Learning Plan Normal daily schedule
Nov 1-Nov 16 Design and Experiment Normal daily schedule, Learning Plans guide learning
Nov 19-23 Thanksgiving Break
Nov 25-Dec 7 Design and Experiment Normal daily schedule, Learning Plans guide learning
Dec 10-Dec 11 Exhibition, portfolio and competency preparation
Dec 12-19 Exhibition week Dec 20 Advisory Day
Quarter 3
Jan 9-18 Learning Plan Meeting—parent/guardian mtgs to update Learning Plan Normal daily schedule
Jan 22-March 7 Design and Experiment Normal daily schedule, Learning Plans guide learning
March 8-11 Exhibition, portfolio and competency preparation
March 12-14 Exhibitions Fair
Quarter 4
March 18-22 April 1-5
Learning Plan Meeting—parent/guardian mtgs to update Learning Plan Normal daily schedule
March 25-29 Spring Break
April 8-May 27 Design and Experiment Normal daily schedule, Learning Plans guide learning
May 13-16 Senior Speeches May 18 Graduation
May 20-28 Exhibitions and Gateway
May 29-30 Advisory Leaving to Learn and All School Celebration
6
Daily Schedules
Monday-Wednesday Schedule Friday Schedule
Tuesday-Thursday Schedule
8:10-8:25 Breakfast
8:30-10:30 Advisory
10:30-12:00 Math/Seminar
12:00-12:40 Lunch
12:45-2:15 Math/Seminar
2:15-3:50 Advisory
8:10-8:25 Breakfast
8:30-12:00 Internship, Exploration, FRCC class
12:00-12:40 Lunch
12:45-3:50 Internship, Exploration, FRCC class
8:10-8:25 Breakfast
8:30-10:00 Mixed Advisory
10:00-11:00 Math/Seminar
11:00-12:00 Math/Seminar
12:00-12:40 Lunch
12:45-3:50 Advisory. Monthly Town Meeting, Clubs, Leaving to Learn
7
BPCCA Glossary of Commonly Used Terms
101, 201, 301, 401 9th, 10th, 11th, 12th graders
Advisor Your teacher
Advisory Home base at school. Approximately 20 students who stay together for 4 years. Your academic family.
Exhibition
Where the student demonstrates accountability for all parts of their Learning Plan. Presented quarterly to a panel of parent(s), student(s), advisor(s), mentor and others who provide feedback.
Exhibition Week Transitions, exhibitions, panels, reflection
Gateway When a 201 student become a 301. The halfway point in the Big Picture school experience
ImBlaze The database students use to search for internships and log hours (attendance)
Independent Work Time (IWT) Time for students to work on their Learning Plans and improve time management and efficiency skills.
Informational Interview One of the first steps in the LTI search process. Help students learn about careers, responsibility and work.
Journal Documentation of learning that students regularly use to record thoughts, feelings, observations, and plans.
Learning Goals
Five general goals provide a framework for thinking about school and internship projects. Big Picture graduates are focused around these five main areas: Communication, Empirical Reasoning, Quantitative Reasoning, Social Reasoning, and Personal Qualities.
Learning Plan
Plan that is written by the student, with input from advisor, mentor, parents and peers. The Learning Plan incorporates the student’s interests and passions and drives their learning for the school year. Includes vision, goals, project work and is updated regularly.
Leaving to Learn Community based experiences that provide learning opportunities for students beyond the classroom.
8
BPCCA Glossary of Commonly Used Terms
Learning Goals
Five general goals provide a framework for thinking about school and internship projects. Big Picture graduates are focused around these five main areas: Communication, Empirical Reasoning, Quantitative Reasoning, Social Reasoning,and Personal Qualities.
Learning Plan
Plan that is written by the student, with input from advisor, mentor, parents and peers. The Learning Plan incorporates the student’s interests and passions and drives their learning for the school year. Includes vision, goals, project work and is updated regularly.
LTI Learning through internship—pursuing passions in the community.
Mentor The adult guide at your internship. Or an expert in a field that you seek help from.
Pick-Me-Up (PMU) and Kick-Me-Out (KMO) PMU’s are fun activities that serve to bond communi-ties, facilitate team learning, and/or build trust.
Portfolio Each student keeps documentation of their work. In a binder, file box or digitally.
Real World Learning
Along with internships, real world learning includes any type of work or learning that happens in authen-tic settings, outside of school. Community service, college classes, and the internship process.
Seminar
Interest based class led by advisor, students, or com-munity members exploring a wide range of topics. Provide opportunities for learning content knowledge, gaining inspiration and acquiring skills.
Senior Institute 301 and 401 specific
Shadow Day
One day experiences at a site of interest to the stu-dent, where the student follows a potential mentor in the work setting. Advisors collaborate with the host site to set up Shadow Days.
Town Meeting Whole school meetings that address school wide issues, conflicts, learning and celebrations.
Week of Welcome (WOW) First week of school
9
Advisory Circle Time: a common part of advisory is circle time. Some advisories do this daily as a morn-ing ritual, while others do it less frequently. Often circle time is used to share about weekends, good news, bummers, questions and brags. Sometimes it is a space for the advisor to ask a question and each student answers. Circles are also a community process for supporting those in conflict and problem solving. Many advisories create a talking piece. This is where the bonding happens. Organization: BPCCA is training students for the real world—college and the work force. Or-ganization is critical for successful adults and students. It is critical that students have a planner, calendar or some organizational system to write down meetings, task lists, questions and to-do items. Paper planners or online systems are good—it just must work for you! Time Management: Students have to get used to an ever changing schedule and wide open peri-ods of work time. Classes change, meetings switch, internship expectations vary, and being on top of project deadlines is important. Setting aside time in advisory to plan your day/week/month is important. Team and Trust Building: A crucial part of advisory is getting to know each other without it feeling forced or contrived. Ideas: advisory breakfast, secret buddy, Pictionary and other games. Journaling: Writing frequently is an essential part of advisory time and a way everyone grows in their writing skills. Guiding questions from other students or your advisor may guide your journaling. Journaling is an important place to process learning at your internship site and can be an important part of your exhibition planning. Minimum 3 times/week Current Events: Keeping students connected locally and globally is important. Advisories may choose to watch a student news show, have students bring in articles to share, or host controver-sial issues to debate. Another idea is a Friday roundtable. The advisor poses a statistic, question or shocking fact relating to a news story and students unpack and discuss it. Autobiography: A series of small moments and scenes from your life that stick out in your mind. The scenes have formed you into the person you are and will become. Your advisor facilitates the writing of this, checkpoints, editing and submission. This is an ongoing assignment and can be written as one long story, short stories and/or split into chapters. Reading: Some advisories read a book together, while others have a requirement of independent reading and others do both. You become better at reading and writing by reading. School Issues: Inevitably there will be issues with the school culture and discussing the problem needs to be done in advisory. Someone feels wronged or there was an incident at school—it is in advisory that you gather in a circle and discuss it. Larger school issues may also be addressed at town meetings. Announcements: Advisory is where announcements can take place, seminars are suggested, leaving to learn opportunities are explored, etc...
Pages –75 at graduation
101 10 pages
201 25 pages
301 25 pages
401 15 pages
10
Building Response Plan for Student Behavior
Non-Emergency Situations BPCCA is designed around personalized education and working with students and fami-lies to provide support, challenge and encouragement for students so they can thrive ac-ademically and personally. BPCCA uses Restorative Practices to help students take accountability for their actions, recognize the impact their behaviors have on others, and make a commitment to what they can do to help themselves and others thrive. Advisors work with students, parents, mentors and administrators to support students when behavior issues impact the learning environment. Advisors use a variety of strate-gies with an emphasis on relationships and student accountability.
Be Kind to Self • Be Kind to Others • Be Kind to Property
Advisor Interventions Warnings, contracts, structured and high-ly supervised independent work time, parent contacts, school and family con-ferences, advisory circle meetings, re-storative options, restorative circle Possible violations include: Academic integrity, advisory disruptions, excessive cell phone use, theft, unpro-ductive independent work time, behav-iors impacting the advisory, violation of advisory norms, tardiness, attendance concerns, dishonesty, work refusal
Adminstrator Interventions Determines consequences based on previous strategies, BPCCA student handbook and Mapleton Public Schools handbook. Restora-tive practice options. Administrator follows through on consequences, contacts parents, and provides feedback to advisor. Possible violations include: Bullying/harassment, excessive behaviors that impact advisory culture, major disrup-tions to the learning environment, off campus behaviors, truancy, theft, drug/alcohol use, fighting, weapons
Restorative Options for Harm to the Community • Community service • Apology letters • Advisory presentations • Restorative circles • Research and write about an agreed upon topic (i.e. building a positive community)
11
Student Expectations Academic Expectations - BPCCA is committed to the Big Picture Learning Goals: Empirical Reason-ing, Quantitative Reasoning, Social Reasoning, Communication, Personal Qualities. The LTI is a main learning opportunity for students to explore possible career choices for their future. We expect our stu-dents to develop a growth mindset. Each student will be formally assessed on their growth during exhi-bitions at the end of each grading period. Attendance—Consistent attendance is imperative for student success. Students are expected to be pre-sent in school or at a secured internship during scheduled times. Families must call the BPCCA office if a student will be absent. According to Mapleton policy, an absence can be excused if it is due to: “illness, injury, danger to health from exposure, death of an immediate family member, time required for doctor/dental appointment, absences due to mental or emotional disability and absence pre-approved by administrator.” All other absences are unexcused. A doctor note or court documentation is required to support an excused absence. The state of Colorado considers a student truant if they have four or more absences in a month or 10 during a school year. If a student is regularly unaccounted for, we are com-mitted to finding that student and working to find solutions to support their regular attendance, using restorative justice circles, parent/advisor conferences, referral to admin or to district truancy court. At-tendance Line: 303-853-1688 Tardies –Students are responsible for being where they need to be at the appropriate times. Showing up on time and respecting the time of others is incredibly important. If tardiness becomes a problem the advisor and student will address the issue to find a resolution. Referral to administration, parent confer-ence, community service or contracts may be imposed if tardies continue. Technology –Must of student learning happens online, but it is important for us to help students main-tain a balance between the use of technology and actively engaging in learning. We work to set norms within advisory for technology use and monitor how it may be impacting student productivity. 401 and 301 students have the option to check out a laptop and charger to use for the year. Students are responsi-ble for the equipment and fines they may incur. Laptops are available to check out during the school day for 101 and 201 students. (Class of 2021 students are grandfathered into the 1:1 laptop privilege if they followed expectations as a 101.) Building and campus clean-up—BPCCA building, campus, rooms and materials are available for stu-dents and staff use and ALL community members must work together to create systems, schedules and accountability to ensure that our campus is taken care of. Off Campus Privileges for Lunch—Students who are in the Senior Institute (301 and 401 students) have the opportunity to leave campus during lunch. Students are expected to follow all school policies when off-campus. Failure to do so may result in loss of off campus lunch privileges. 101 and 201 stu-dents who leave campus may jeopardize their future off campus lunch privileges and have consequences that may include restorative practices or discipline. Drugs, Alcohol, Illegal Substances, Paraphernalia, Use and Possession—We do not allow any activi-ty involving illegal substances. Our commitment is to the well-being of all students. If a student is found to be in violation of the district policy, that student may be required to submit to; restorative sessions, drug/alcohol assessment(s), and follow certain treatment recommendations. Respect for Cultural Diversity: Our community includes people from all cultural backgrounds. Stu-dents have the opportunity to learn from their peers in matters of language, race, gender, class, religion, disabilities, sexual orientation, and other cultural traditions identities. Students are expected to offer the same kind of respect they would expect from others.
12
Student Expectations continued Appropriate Attire—Students are expected to dress appropriately for the class they are attending. Clothing should not be worn with explicit portrayals of violence, sexual activity, or drug use and alcohol use. Restorative Practices and Restorative Justice—Our desire for BPCCA is to proactively build a posi-tive school community and reduce discipli-nary referrals, suspensions, and expulsions. Restorative Practice is a proven framework for building a community where every stu-dent and adult is respected and given the opportunity to fulfill their greatest potential. Restorative practices are embedded in the 5 Rs: Relationships, Respect, Responsibility, Repair, Reintegration. The focus of restorative practice is to repair harm done to people and relationships ra-ther than to punish the offender. At BPCCA, you will see Restorative Prac-tice principles at work at every level, from the way adults interact with students to the way we handle discipline issues to the re-spectful, empathetic ways students interact with each other. We refer to the day-to-day use of these principles as Restorative Practice. In addition to building our school culture through RJ and RP, we also use a restorative approach to disci-pline issues. This may look very different from what you’re used to: Conventional/Retributive Justice Restorative Justice 1. What is the law that was broken? 1. What is the harm that was done? 2. Who broke that law? 2. How can we repair that harm? 3. How should they be punished? 3. Who repairs the harm? Restorative Practice works because it gives offenders the chance to change and gives victims the respect and power of being part of ‘making things right.’ We will always approach discipline issues from a re-storative perspective, whether that’s through a simple discussion or a complete Restorative Circle. In a classroom setting, this might look like:
Teachers engaging a disruptive or distracting student in a restorative conversation. In that conversa-tion students will be required to reflect on their behavior and how their behavior affects those around them, describe what happened, explain what they were thinking during the behavior and what they are thinking now, and then offer a way to repair the harm their behavior caused.
If a student is not able to reflect in that moment, or the teacher needs to continue classroom instruc-tion, a student may be asked to complete a reflective statement before they talk to their advisor. The student would be removed to a different setting, ideally with another staff member, while completing the statement and while classroom instruction continued.
If a restorative conversation is not successful, teachers may refer students to an administrator.
13
Learning Plans
The Learning Plan—a personalized proposal on what students want to learn and how they will get there—is the first piece of work every student and staff member must complete at BPCCA, and continue to complete quarterly. A Learning Plan is created at the beginning of the year and revised regularly in Advisory and at Learning Plan meetings.
Competencies Empirical Reasoning (ER) is the ability to think like a scientist. To use empirical evidence and a logi-cal process to make decisions and evaluate hypotheses. It also involves making connections to scientific content, such as biological processes, physics or chemistry. "How do I prove it?" Social Reasoning (SR) is the process of thinking like a historian or an anthropologist. It involves seeing diverse perspectives, understanding social issues, exploring ethics and looking at issues historically. "What do other people have to say about this?" The Communications learning goal helps us to be effective communicators. We consider how to un-derstand our audience. How to read, write, speak and listen well. And how to use technology and artis-tic expression to communicate. "How do I take in and express information?" Quantitative Reasoning (QR) is when we think like a mathematician. We work to understand numbers and data, to analyze uncertainty, to comprehend the properties of shapes, and to study how things change over time. "How do I measure or represent it?" Personal Qualities (PQ) are the ways we push ourselves to do our best work. This learning goal may include organization, leadership, time management, as well as things like demonstrating respect, collab-
oration and reflecting honestly on strengths and areas for growth. "What do I bring to this process?"
14
Mapleton Graduation Requirements **22 total credits (15/14 core credits) are need-ed to graduate from Mapleton Public Schools
Letter Grades: All courses receiving a letter grade will be used in computing student’s grade point average (GPA).
Standard Grading Scale:
A = 90 -100% A = 4.0 points
B = 80 - 89.9% B = 3.0 point
C = 70 - 79.9% C = 2.0 points
F = 69.9% & below F = 0.0 points
Grade Point Average: Courses marked with a “P” are not calculated into GPA.
Class Rank: Class rank is based on the student’s cumulative grade point average. School Year: BPCCA is on a quarter system and students receive final grades at the end of each quarter.
Requirements:
School-Specific Coursework and/or Experiences:
Unique learning requirements that focus
on additional required course work, advisory, and community based learning.
Capstone Exhibition:
Includes public exhibition/passage, independent research project, service
learning, assessment data.
Demonstration of Community Awareness and Engagement:
Use of academic skills to solve real
community issues. 40 hours community service
Demonstration of College Readiness:
Program that supports student completion of the college selection and application/
acceptance process.
Subject Total Needed
Requirements
English 4
Math
4 3
Class of 2019/2020
Class of 2021 and beyond
Social Studies
3 Hist (1.0)____
Civics (.50) ____
Science 4 At least 2 credits must
be lab-based
Foreign Language 1
Must be same language for entire 1
credit
Physical Education
.50
Health .50
Technology .50
Art .50
Capstone .50 Senior year requirement
Electives 6/7 Includes Financial
Literacy and 40 hours community service
Total 22
Credits
15
Projects
Projects are a foundational part of Big Picture learning. Students will be working on multiples projects during the quarter. Students are responsible for setting multiple project dead-lines, in consultation with their advisor, in their Learning Plan. Projects are a key element of homework and should be worked on every day. Projects should be interest based and driven by a student’s passions. In addition, pro-jects should support their work at the internship, be deep, rigorous and have authentic meaning. All students should have a minimum of two projects at all times—including a meaningful pro-ject at their internship site and one they are working on at school. All projects should be graded collaboratively by a rubric that is developed by the student, advi-sor, mentor and parent.
16
Internships
BPCCA Internship Program (LTI) Learning through internships (LTI’s) is one of the core aspects of the BPCCA curriculum. LTI’s
place students in real-world settings with mentors who have expertise in that field. The LTI
may take place at a small or large business, a school, or within a community-based organiza-
tion. The mentor will connect student’s learning to the real world and act as a role model, re-
source, and guide. While students are learning about specific job fields, they are also working
to benefit the organization through a project. Students are expected to design internship pro-
jects that align with their Learning Plan. Students are responsible for coordinating transporta-
tion with the consultation of their families and advisor.
Four-Year Internship Overview
101 (9th
grade) year — BPCCA Students will spend the first part of the year learning about the
internship process, including how to dress professionally, how to write and use phone scripts,
how to research interest-based internship sites, and how to schedule and attend informational
interviews and shadow days. Advisors may take groups of students on volunteer outings to
model skills and prepare students.
• Once an Advisor and student determine the student is ready, they will begin job shadows,
interviews, and looking for a professional internship.
201, 301, 401 years — After spending the first few weeks in advisory designed to refresh their
understanding of professional/business skills, BPCCA students will seek internships that align
with their interests.
NOTE: The success of our internship program relies on locating new sites for our stu-
dents. If you or someone you know works for/with a company or organization that is
interested in learning more about our program, please contact the BPCCA main office.
17
Exhibitions
Exhibitions are public presentations by students about what they have done and what they have learned. Students give an oral presentation on their personal learning plan and learning through internship work. The audience may consist of their advisor, parents, peers, mentors and other staff. Big Picture schools personalize learning for every student and exhibitions provide an authentic way to assess each student’s learning and development.
18
Concurrent Enrollment
Requirements to prove readiness to begin taking college classes supported by
BPCCA:
I. A student’s Learning Plan and team (parent/guardian, advisor, mentor, post second-
ary options coach) supports the goal of starting concurrent enrollment.
II. Accuplacer Scores – must meet FRCC score requirements
III. Good school and internship Attendance
IV. Demonstrated Work Ethic—Regularly participates in Learning Plan, including goals
and timelines. Manages time well and shows proficient project completion.
V. Demonstrated Study Practices
Use of effective note-taking
Use of effective study methods
Willingness to be coached and attempt new methods
VI. Use of General Resources
Regular and effective use of appropriate human and
material resources
VII. Personal Qualities – students must demonstrate the
following, as determined by BPCCA staff and student Ex-
hibition Panels (parents, peers, and staff):
Maturity
Time Management
Responsibility
Honesty
Positive role modeling and membership in the com-
munity
VIII. Commitment and enrollment – Must complete all
enrollment commitment forms (online and written) as
required by college, BPCCA, and Mapleton Public Schools
IX. BPCCA reserves the right to limit the number of clas-
ses a student may take in order to guarantee access to
concurrent enrollment for a greater number of students.
19
Big Picture College and Career Academy Student Commitments 2018-2019
As a BPCCA student I understand that I am responsible for my learning and I respect and val-ue the learning of all students and staff at BPCCA. I have the opportunity to drive my own learning to meet graduation requirements and acknowledge that I play a key role in my suc-cess at BPCCA. I will work each day to help myself reach my best potential. I understand the BPCCA requires students to: Work closely with an advisor who provides guidance and support as students engage in
school and develop Learning Plans Actively participate in Advisory and restorative practices Reach beyond school to establish and attend internships and real world experiences 2
days per week Engage in rigorous project work, both independently and collaboratively Establish time management, organization skills, and self-motivation Find inspiration to lead their own learning while being immersed in a collaborative school
environment Contribute to a positive and respectful school culture Be kind to yourself, be kind to others, be kind to property Learn how to learn, think critically, and solve complex problems Gain the confidence to push themselves and develop positive beliefs about themselves as
learners Develop the maturity to communicate with adults in the workplace, as well as school Develop the courage and skills to explore interests, passions and talents Present academic work through frequent public exhibitions and a portfolio Explore a wide variety of colleges and career options Attend school every day and be on time Abide by all Mapleton Public Schools policies and procedures Exhibiting a pattern of not honoring these commitments will result in varied interventions up to and including discussion about the appropriateness of student’s placement at BPCCA. By signing below I acknowledge that I have read and understand the contents of the student handbook and agree to the commitments. Agreed to by:
Date: ___________________
Student Name: ________________________________________________
Student Signature:______________________________________________
Parent/Guardian Name: __________________________________________
Parent/Guardian Signature: __________________________________________