Counseling Department. This may involve group activities and/or individual sessions.

The following person(s), including parents may check the student listed above, out of Pickens County High School. No one will be allowed to check out a student if his/her name does not appear on this list. Please provide first and last name. Please do not write on the back of this form. ONLY ONE FORM PER STUDENT SHOULD BE SUBMITTED TO THE MAIN OFFICE.

• Students will be allowed to bring cell phones to school.
• Phones may be used only with permission of school personnel.
• Phones must be out of sight and powered off unless directed by school personne l to do otherwise.
• Cameras, videos, text messaging, or any other function available on a cell phone that invades the privacy of another individual is expressly prohibited on school grounds at any ti me.

Consequences for Cell Phone Usage:

• 1st Offense: Phone will be confiscated and locked up in the office and stude nt will be written up. Parents will be allowed to pick up the phone at the end of the schoo l day, after 3:11 pm.
• 2nd Offense and any other offense: Phone will be confiscated and locked up in the office. Student will be written up and will be subject to suspension (in and/out of school

*School Personnel will NOT be responsible for replacing lost or stolen cell phones*

On occasion our school or representative/employees of the Alabama State Department of Education wish to photograph, videotape, and/or interview individuals in connection with a school activity or project. One of the primary purposes of this photograph, videotape and/or interview is to enhance student learning, encourage excellence in teaching or recognize students that are excelling. Although the videotapes involve both the teacher and various students, the primary focus is on the instruction of or recognition of students.

In order to release photographs, video footage and/or comments that are posted on district school websites, we need written permission. To give your consent, please complete the form below.

Give permission for my child to be photographed, videotaped and/or interviewed by our school or representatives/employees of the Alabama State Department of Education for educational or public relation purposes. I authorize the use and reproduction of any and all photographs and/or videotapes of my child, without compensation to me or my child. All of these photographs or video recordings shall be the property, solely and completely of Pickens County High School. I waive any right to inspect or approve the finished photographs/videotapes, the soundtrack, script or printed matter that may be used in conjunction with them.

Please, complete the following survey. The results of this survey will be used to determine if you are possibly eligible for the Migrant Education Program.

Are you or your spouse working or have you worked in an activity

directly related to some of the following? Please, check (√) all applicable:

Por favor de completar la siguiente encuesta. Los resultados de ésta encuesta serán usados para determinar si son posiblemente elegibles para el Programa de Educación para Migrantes.

2. ¿Usted o su cónyugue trabajan o han trabajado en una actividad

directamente relacionada an algunas de las siguientes? Por favor de marcar () los aplicables:

Pickens County High School and the parents of the students participating in activities, services, and programs funded by Title I, Part A of the Every Student Succeeds Act of 2015 (ESSA) (participating children), agree that this compact outlines how the parents, the entire school staff, and the students will share the responsibility for improved student academic achievement and the means by which the school and parents will build and develop a partnership that will help children achieve the State’s high standards.

This school-parent compact is in effect during the current school year. 

Pickens County High School will:

1. Provide high-quality curriculum and instruction in a supportive and effective learning environment that enables the participating children to meet the State’s student academic achievement standards as follows:

Provide a safe and productive learning environment for all students Hold PTO meetings monthly Keep web pages and Inow home portal updated Use current materials and data to enhance instruction Incorporate technology into the weekly lessons

2. Hold parent-teacher conferences (at least annually in elementary schools) during which this compact will be discussed as it relates to the individual child’s achievement. Specifically, those conferences will be held:

PTO meetings will be held once a month

3. Provide parents with frequent reports on their children’s progress. Specifically, the school will provide reports as follows:

Progress reports will be sent out every three weeks and parents will have access to the INOW portal to view grades and other pertinent information.

Pickens County High School will use a variety of the following methods:

• Progress reports
• Emails/texts

4. Provide parents reasonable access to staff. Specifically, staff will be available for consultation with parents as follows:

• Teachers will provide their available days and hours during planning or after school on the school website and syllabus so that parents can call to schedule a conference time.
• Faculty and staff will ensure to bring proper documentation of the student’s progress academically and/or socially for conference.
• Counselors will provide parents with scheduling sessions/calendars upon request

5. Provide parents opportunities to volunteer and participate in their child’s class, and to observe classroom activities, as follows:

• Parents may call the school and schedule a time to come and volunteer, participate, and observe in the classroom.
• Invite parents and guardians to chaperone and/or assist with various school sponsored events

6. Ensure regular two-way, meaningful communication between family members and school staff, and, to the extent practicable, in a language that family members can understand.

• Use the school website; Notify Me; newsletters; email; planners; Remind; parent conferences, meetings and calls; Interpreters, and INow Home portal to communicate with parents.

We, as parents, will support our children’s learning in the following ways:

• Responsible for attendance
• Establish appropriate quiet time for homework/study
• Make sure student has appropriate school supplies
• Volunteering in my child’s classroom.
• Participating, as appropriate, in decisions relating to my children’s education
• Promoting positive use of my child’s extracurricular time (ie. Television & technology)
• Serving, to the extent possible, on advisory groups, such as Title I advisory committees and parental involvement committees, as well as volunteering in the classrooms
• Use internet notifications to check students’ grades
• Serve as a positive role model for my child
• Support discipline policies of the school

Student Responsibilities (revise as appropriate to grade level)

We, as students, will share the responsibility to improve our academic achievement and achieve the State’s high standards. Specifically, we will:

• Do my homework every day and ask for help when I need to
• Give to my parents or the adult who is responsible for my welfare all notices and information received by me from my school every day
• Promote positive use of my extracurricular time
• Follow school discipline policies
• Bring appropriate school supplies
• Attend school regularly and arrive on time
• Refrain from bullying
• Promote positive behavior and attitude
• Complete and return all assignments on time

School Representative Signature

If yes, please provide school name(s), state, and dates attended:

If you responded “Yes” to question number 6 above, please answer the following questions:

What language did your child learn when he/she first began to talk?

What language do you most frequently speak to your child?

Within the Pickens County Primary Care (PCPC), the certified SMART Student Health and Wellness Center’s purpose is to support student academic achievement and competency through the proactive provision of preventive, basic primary, and behavioral health care and urgent care to all of our students, school faculty and staff, and their families to positively impact the trajectory of lives. In order to achieve this, the SMART Model is focused on proactively ensuring the wellness of ALL students in the building, in addition to reacting to acute care needs by deploying Active Access to Active Care. The SMART Clinic is open when school is in session with a flexible, rotating schedule. The staffing model may include a nurse practitioner, physician’s assistant, physician, behavioral health practitioner, and dental care professionals. The SMART Clinic at Reform Elementary School is also extending its services to children enrolled in the Pickens County Head Start and Pre-K Program during regular school hours.

I authorize and consent to the enrollment of the above-named minor, of whom I am the parent or guardian. My consent will allow the qualified professional staff of the PCPC SMART Clinic located at my child’s school, or any other SMART Clinic location to be opened in the future in Pickens County, to provide comprehensive medical and behavioral health services to my son/daughter. This consent is valid for the duration of the above-named minor's enrollment at the Pickens County Head Start and Pre-K Program and/or in Pickens County Schools. I understand that no medical experiments will be conducted on my child, and that I may withdraw my consent by notifying the PCPC Reform SMART Clinic, in writing.

Services available to students, faculty and staff and their families can include, but are not limited to the following: Preventive and ScreeningsBasic Primary and Urgent Care

• Wellness assessments
• All CDC recommended immunizations*
• Vision and hearing screenings
• TB screenings and referral to care
• Routine diagnostic laboratory testing
• Dental screening and referral to services
• Risk factor screening and counseling

• Physical and routine annual exams
• Sports and employment physicals
• Diagnosis and management of chronic health

• Screening, diagnosis and treatment of routine

• General health assessments
• Brief individual interventions
• Group behavioral sessions
• Assessment of stress/emotional problems
• Family counseling to support students’ needs
• Outpatient psychiatric care

• Asthma treatment
• Treatment of sprains, lacerations, minor burns and

I understand that the SMART Clinic staff may request additional forms pertaining to certain types of treatment or procedures for my child. I understand that may child may be transported to the PCPC SMART Clinic by school or clinic staff, if the clinic is not located in my child’s school. Additionally, I acknowledge that some medical and dental services may be provided at a PCPC community health center to my child, and I will be notified. I further understand that the medical records maintained by the SMART Clinic are confidential. I authorize the school/Head Start/PCS pre-school program to release medical and school records to the SMART Clinic team, and also for the SMART Clinic to release medical records to the school/Head Start/PCS pre-school program and to my health care provider, and I understand that this information will be used to facilitate my child’s care and shared to evaluate and improve services provided. I also authorize my child’s other health care providers to release information to PCPC, as needed. I understand that the PCPC Notice of Privacy Practices is available to me on the PCPC website http://www.pc3med.com/forms.html, or I can request and obtain a printed copy at the SMARTClinic. The health center staff considers parental involvement extremely important. We encourage all students to involve their parent or guardian in health care decision-making. I understand that older children may consent to certain types of services, and that confidentiality between the student and the SMART Clinic professionals will be ensured in specific areas designated by Alabama law, and will not be discussed with the parent/guardian, unless the student agrees.

, a student enrolled in Pickens County

hereby acknowledge by our signature that we have received and read, or had read to us, the foregoing handbook.

This sheet is to be returned to the student’s first block teacher. Contained in this handbook are policies approved by the Pickens County Board of Education.

The student will not be officially enrolled until this form has been signed and returned within five (5) days of receipt.

The Parental Responsibility Act of 1994 (Code of Alabama, 16-28-12) requires the following:

1. Students and parents, or guardians or other persons having control or custody of a child must sign that they have received a copy of the school board’s policy on behavior standards.

2. Principals must report to the superintendent any parent, guardian, or other person having control or custody of a child who fails to attend school or who fails to have the child properly conduct him/herself at school. The superintendent must report the violators to the District Attorney within ten (10) days.

3. The parent, guardian, custodian, or other person responsible for the care or control of the child is financially responsible for the child’s destructive acts against school property or persons.

377 LaDow Center Circle~~Carrollton, Alabama 35447~~Telephone: (205) 367-2080~~Fax: (205) 367-8404 Website: www.pickenscountyschools.net