Pinecrest Academy Charter South Elementary School Pirate Safety Patrol Information & Application

The Pinecrest Academy Charter South Elementary School Safety Patrol Team has been established to recognize those students who possess and demonstrate positive leadership skills, personal responsibility, dedication to their school work and a commitment to serve others at the school. The goal of the safety patrol is to allow its members to explore and develop such important leadership skills as responsibility, dependability, assertiveness and cooperation. The safety patrol assists the school's teachers and administrators in morning arrival and afternoon departure of students.

In order to become a member of the Pinecrest Academy Charter South Safety Patrol:

1) Students must meet the following qualifications:

The student must:

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  have a good attendance record
  
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  be punctual (7:55 a.m.)
  
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  be responsible
  
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  be a good leader and show leadership potential
  
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  be a positive role model
  
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  have self-control
  
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  follow directions
  
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  pay attention
  
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  be respectful to self and others
  
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  be reliable
  
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  be mature
  

Patrols must be 5^th grade students who are willing to come to school early for morning arrival and stay late for afternoon dismissal. They are selected by recommendation from teachers, administrators, and patrol sponsors. Attendance and tardiness are also seriously considered. Consideration is based on student interest, attendance, academic achievement, behavior, conduct, commitment, sense of responsibility, leadership potential, and attitude toward others. In most cases, students who are dedicated to their school work will be dedicated to patrol responsibilities. The job of safety patrol is one that is taken seriously at Pinecrest Academy South.

Student Name ______________________________________________________

Classroom Teacher __________________________________________________

All patrol students must receive training prior to serving as a patrol.

I hereby apply for membership in the Pinecrest Academy Charter South Elementary School.

If accepted, I will obey the pledge below and other rules and regulations of the Patrol.

I promise to do my best to:

Set a good example in all areas of school life

Obey my teachers and leaders of the patrol.

Earn the respect of fellow students.

Perform my duties faithfully.

Prevent accidents.

Report dangerous practices of students.

Report for duty on time.

I hereby accept that the above mentioned responsibilities will be mine to uphold. I understand that as a Pirate Patrol, I am responsible for being a role-model for my peers and will advocate my pirate values to the highest esteem.

_________________________________ __________________

Student Signature Date

Pirate Safety Patrol Disciplinary Action:

Consequences for not wearing safety uniform or for neglecting to do your duty properly:

• 
  1^st Offense: one week suspension from patrol
  
• 
  2^nd Offense: dismissal from patrol
  

• 
  1^st Offense: one week suspension from Safety Patrol
  
• 
  2^nd Offense: dismissal from Safety Patrol
  

• 
  1^st Offense: one week suspension from Safety Patrol
  
• 
  2^nd Offense: dismissal from Safety Patrol
  

To the PARENT OR GUARDIAN:

The position of Safety Patrol is taken seriously at Pinecrest Academy. A desire to participate does not mean a student is qualified to assist in this position. It is important that a Safety Patrol knows and understands the seriousness of safe practices. If students do not abide by classroom rules or they receive an office referral they may be dismissed from their Patrol position. If Patrol members are disrespectful or put themselves or others at risk they will be removed from their patrol position. Safety Patrol members must set positive examples for other students to follow in their behavior and work ethic. Having read the Safety Patrol pledge and explanation of the duties, responsibilities and consequences for inappropriate actions of the AAA Pirate Safety Patrol outlined on this form, I hereby give my consent to have my (son/daughter) ________________________________________ apply and/or serve as a member of the AAA Pirate Safety Patrol. As a parent of a patrol member I will do my best to obey drop off, pick up and crossing guidelines as well as school rules. I realize that it is my responsibility to set a good example for my child to follow. I understand that these guidelines were established to provide safety for the Pinecrest South Community.

Name: ___________________ Phone: __________________ (home) ___________________ (cell/work)

Address: ______________________________________________________________ (include zip code)

E-mail address: ________________________________________________