Code of Conduct Acknowledgement Form 2022-2023

Code of Conduct Acknowledgement Form

2022-2023
School*
Name*

First NameLast Name
Student ID#*
Date of Birth*

MonthDayYear
Date
Grade*
STUDENT & PARENT ACKNOWLEDGEMENT:

By initialling below, I acknowledge that:
1. I (student) have received a general overview and specific instruction of the contents of the Polk County Public School’s Code of Student Conduct.
2. I (student) have also been informed that compliance with the Code is mandatory. The Code is located on the School Board website at ; for review and download. KEYWORD : Student Code of Conduct.
3. We are aware of the contents of the Plk County Public school's Code of Conduct and have been informed that compliance with the code is mandatory.
Student Signature*

Clear
Name of Student *
ID#*
**Reminder: Discovery Academy of Lake Alfred’s administration reserves the right to dismiss students for serious breaches of conduct. Appeal procederes are conducted through Discovery Academy’s administration and/or Governing Board.
Parent Signature*

Clear
Name of Parent/Guardian *
Parent/Guardian Email
Date*

MonthDayYear
Date
Carol Fulks, Executive Director Kevin Warren, Principal

1000 North Buena Vista Drive Lake Alfred, FL 33850 863-295-5955 www.discoveryacademy.org
Should be Empty: