In the space provided, please check the appropriate spaces and in the lined area write explanations to support the areas you have checked. Please give your best recommendation of the student using the following criteria:
1. I understand that there will be no overnight visiting with friends while participating in the 2017 Crossing Our Bridges Health Academy.2. I will follow the rules and regulations of my school. 3. I will keep regular attendance at the Academy classes and activities.4. I will follow curfew regulations for the program.5. I will not possess or use any drugs, alcohol, tobacco, or weapons while participating in the 2017 Crossing Our Bridges Health Academy program, and violation of this may result in my being sent home immediately at my parent/guardian’s expense. 6. I understand that violation of any state, federal, or municipal laws; such as stealing, shoplifting, etc., will result in my immediate removal from the Academy program at my parent/guardian’s expense.7. I will show respect, honesty, courtesy, and cooperation toward my fellow students, and all Academy staff.8. I understand that I will not be allowed to drive a motorized vehicle while participating in the Academy.9. I will practice good health and hygiene habits, including limiting sugary snacks.10. I will use appropriate language at all times.
I CERTIFY THAT ALL OF THE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND THAT I HAVE READ AND UNDERSTAND THE ABOVE STATED RULES AND REGULATIONS. I REALIZE THAT ANY VIOLATION OF THESE RULES MAY RESULT IN MY BEING DISMISSED FROM THE PROGRAM AT THE PARENT/GUARDIAN’S EXPENSE.
Grooming Itemso Toothbrush, toothpaste, dental flosso Soap (in a zip lock baggie)o Shampooo 1 bath towel & washclotho Comb or Brush
Do Not Bring These Itemso Valuables of any kindo Weapons of any kindo Drugs, Alcohol or Tobacco o Radios/CD playerso Electronic games