SAMPLE
XYZ
Charter
719 Fourth Street
Anytown, TX
555/555-1234
STUDENT HANDBOOK
ACKNOWLEDGEMENT FORM
Please read the
following information carefully.
Parents
and student must sign this form.
I understand and consent to the responsibilities
outlined in The XYZ Charter 20xx/20xx Student Handbook. I understand and agree
that my child will be held accountable for his or her behavior and consequences
as outlined in this document. They will be held accountable at school,
school-sponsored and school related activities, including school-sponsored
travel. I understand that any student who violates the code of conduct is
subject to disciplinary action as outlined in this Student Handbook and which
may include referral for criminal prosecution. I further understand and consent
to my parental responsibilities as outlined in this handbook.
Failure to sign this form does not remove my child’s responsibility to abide by the stated policies.
Parent
or Guardian Name: ______________________________________________________
Parent
or Guardian Signature: ___________________________________________________
Student
Name: _______________________________________________________________
Student
Signature: ____________________________________________________________