Safety Patrol Application
Pond Springs Elementary Safety Patrol Application

Dear Parent/Guardian,

It's time to train Fourth Graders for Safety Patrol! Fourth Grade training will begin in late April or early May. (The schedule for training depends on how many students sign up to work. A note will be sent home showing your child's training days.) Safety Patrol students open and close car doors in the front and back driveways before and after school. They also help raise and lower the flags. We feel this service is a very important lesson in safety, courtesy, volunteerism and responsibility for your student. We strive to make it a positive experience for them and your support is very important in obtaining that goal.

Because Safety Patrol duty is a privilege and they represent Pond Springs to the public, we require
students to have, and maintain certain qualifications to be accepted.
Students must always:
• Have and keep passing grades
• Exhibit good leadership qualities including good citizenship grades
• Have parent/guardian approval and support
• Have approval of Safety Patrol directors and classroom teachers
• Be prompt and committed to safety rules
• Be able to work daily for a four to six-week period (7:20 -7:35 AM or 2:50 -3:10 PM)
• Be able to communicate with students and adults politely and cheerfully
• Always being good role models worthy of respect
• Report any perceived dangerous safety violations to the teacher on duty

Students may be removed from Safety Patrol for not complying with any of the above requirements. If a student wishes to resign, we must have a written request from the student and parent/guardian.

Please complete the form below and click submit when you are done. If changes need to be made to your information, please call and leave us a message. You will not be able to make on-line changes once you have submitted your information. (Only P.S.E. staff assisting with Safety Patrol organization will have access to the information.) Thank you for your interest in working on the Safety Patrol team! We look forward to working with you!!

Mrs. Thweatt and Mrs. Dwyer
P.E. Department
512-464-4211


First Name
Student's First Name
Your answer
Last Name
Student's Last Name
Your answer
Teacher
Please click on your current teacher's name
Preferred Time
Please click on the time slot(s) for the time(s) that you would like to work. Morning 7:20-7:35 a.m., Afternoon 2:50-3:10 p.m., or either time of day..
Required
Parent/Guardian Name
Your answer
Phone
Parent/Guardian Phone Number where you can be reached during the school day.
Your answer
Parent/Guardian Name
Your answer
Phone #2
Parent/Guardian Phone Number where you can be reached outside of the school day.
Your answer
E-Mail
Parent/Guardian E-mail address
Your answer
Student Agreement
By checking this box, I agree that I must always: • Have and keep passing grades • Exhibit good leadership qualities including good citizenship grades • Have parent/guardian approval and support • Have approval of Safety Patrol directors and classroom teachers • Be prompt and committed to safety rules • Be able to work daily for a four to six-week period (7:20-7:35 AM or 2:50-3:10 PM) • Be able to communicate with students and adults politely and cheerfully • Be a good role model worthy of respect • Report any perceived dangerous safety violations to the teacher on duty. Students may be removed from Safety Patrol for not complying with any of the above requirements. If a student wishes to resign, we must have a written request from the student and parent/guardian.If accepted for Safety Patrol Duty, I agree to follow the listed requirements.
Required
Parent Agreement
I have read the above application and regulations. By checking this box, I hereby give my consent and support for my student to serve as a member of the Pond Springs Elementary Safety Patrol.
Required
Submit
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