Homework Center Permission Slip 17-18
Please make sure you read the agreed upon Homework Center Rules on The UMS Website.
Go to: About UMS > Parent and Student Handbook > see page 21.
Parents Name: *
Your answer
Parent Signature : I __________________________, *
do hereby give permission for my son/daughter to participate in the Homework Center and have discussed the Center’s rules with him/her. I understand that using the Homework Center, its tutors and resources is a privilege and not a right. I also understand that if my son/daughter does not follow the rules, he/she will be excluded from the use of the program.
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Date: *
Your answer
Students Name: *
Your answer
Student Signature: I _______________________, *
understand the expectations for attending the Homework Center. I understand that I will be prepared with adequate work and materials to make good use of my time in the Center. I also understand that if I do not follow the expectations and instructions of the Center or its staff, I will not be allowed to attend the Center. By signing this, I acknowledge that I have read the rules on the back of the sheet.
Your answer
Emergency Contacts: *
In case of an emergency, we need to have some emergency contact numbers in the Center’s database. The school office closes at 4:00; the Homework Center is open until 4:30. Please list names and numbers of AT LEAST 2 people who are authorized to pick up your student if we are not able to reach you.
Your answer
Name/Relationship: *
Your answer
Phone Number: *
Your answer
Name/Relationship: *
Your answer
Phone Number: *
Your answer
My child must call me for permission to leave earlier than 4:30 each day they attend. My child may also present a note indicating an early dismissal. I understand that my child is to leave campus by 4:40 each day. If applicable, I understand that I am responsible to pick them up by 4:40 each day. I understand that there is no supervision after 4:30 and continued late pick up may result in Homework Center privileges being revoked. The number my student will call if he/she leaves before 4:30 is: (type phone number here) *
Your answer
My child must call me for permission to leave earlier than 4:30 each day they attend. My child may also present a note indicating an early dismissal. I understand that my child is to leave campus by 4:40 each day. If applicable, I understand that I am responsible to pick them up by 4:40 each day. I understand that there is no supervision after 4:30 and continued late pick up may result in Homework Center privileges being revoked. The number my student will call if he/she leaves before 4:30 is: (type phone number here) *
Your answer
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