Parent & Student Handbook - Independence Charter School

Independence Charter School
2012-2013
Parent and Student Handbook Signature Page
EACH student is required to return this sheet to his or her classroom or advisory teacher.
Teachers will return the signed sheets to Dean Michelle (K-4) and Dean Gina (5-8).
By signing below I acknowledge that I have received the Independence Charter School Parent and
Student Handbook and will read it thoroughly and keep it close at hand for future reference. By
signing below I am indicating that I agree to uphold the Policies and Codes listed within. If my
child is in 5 th , 6 th , 7 th or 8 th grade, I also acknowledge that my child will have an e-mail account to
be used for education purposes; if I do not want my Middle School child to have an e-mail account
at school, I will note that in the space at the end of this page.
_____________________________ ____________________________________ _________
Parent/Guardian’s Name PRINTED Parent/Guardian’s Signature Date
_____________________________ ____________________________________ _________
*Student’s Name PRINTED Student’s Signature Grade
*If you have more than one child at ICS, please list the names of all children and have each child sign.
_____________________________ ____________________________________ _________
*Student’s Name PRINTED Student’s Signature Grade
_____________________________ ____________________________________ _________
*Student’s Name PRINTED Student’s Signature Grade
_____________________________ ____________________________________ _________
*Student’s Name PRINTED Student’s Signature Grade
_____________________________ ____________________________________ _________
*Student’s Name PRINTED Student’s Signature Grade
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My child is in 5 th , 6 th , 7 th or 8 th grade and I DO NOT WANT my child to have an e-mail
account at ICS. I understand that I will be responsible to ensure that my child stays in frequent contact
with his/her teachers to make sure s/he does not miss any assignments.
____________________________ ___________________________________ _________
Parent/Guardian’s Name PRINTED Parent/Guardian’s Signture Date
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