Ms.

DeClemente
Parent Signature Form
Please detach this form & return to school by Monday, September 9th.
This is your first homework assignment!

Name of student: ________________________________ Period: ________________

Mailing Address: _______________________________________________________
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Parent/Guardians Full Name(s)
Name: __________________________ Relationship: ______________________
Home Number: _________________ Work Number: __________________
Cell Number: __________________ Email: ________________________
Name: __________________________ Relationship: ______________________
Home Number: _________________ Work Number: __________________
Cell Number: __________________ Email: ________________________
Best time to call & where: ___________________________________

TEACHER: I will prepare you for the challenges that lie ahead of you. I commit to helping you
succeed.
X
Ms. DeClemente
9/3/13
.

Teacher Signature

Date

STUDENT: I have read the course expectations and understand that I must take responsibility
for my academic advancement, as well as my classroom behavior.
X ______________________________________________________________
Student Signature
Date
PARENT/GUARDIAN: I have discussed the Course Expectations and procedures with my child
and I am convinced my child understands them.
X ______________________________________________________________
Parent/Guardian Signature
Date

In the space provided, please feel free to tell me anything that you would like me to know or
anything that you think I should know about your child.
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