Clifford Pierce Middle School
Consent for H.U.G. Program
Building relationships between the home and the school allows your child to become more successful at Clifford Pierce Middle School. The success of your child in the H.U.G. program depends on your support and participation. This consent form is designed to ensure that you understand your role and responsibilities in the H.U.G. Program.
Read each statement carefully and if you have any questions, please feel free to ask the H.U.G. Coordinator. We are asking that you fulfill the parent/guardian requirements and allow us to work together to make your child successful at Clifford Pierce Middle School. We want this to be a positive experience for your child at home and at school.
Please initial each requirement to indicate that you have read and understand the requirement.
H.U.G. Program Parent/Guardian Requirements:
_____ My child will attend school regularly.
_____ I agree to meet, when necessary, with the H.U.G. Coordinator, team, teachers, counselors, or administrators at a mutually agreed upon time.
_____ I will respond to any contacts made by the H.U.G. coordinator, team, teachers, counselors or administrators and make a necessary response in a timely fashion (within 72 hours).
_____ I will review and sign my child’s check-in/check-out sheet daily, focusing on only the positive.
_____ I will help my child complete homework.
_____ I will support the H.U.G. Program and the team in any decisions they may have to meet the needs of my child. If I have any concerns, I will contact the H.U.G. Coordinator directly.
I understand the H.U.G. Program parent/guardian requirements and will assist my child in being a successful member of the H.U.G. Program. I give my consent for my child to participate.
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Parent Name (please print) Parent Signature Date
I acknowledge that Clifford Pierce Middle School has informed me of the H.U.G. Program and how it will benefit my child. I decline my permission for my child to participate.
____________________ _________________ _________
Parent Name (please print) Parent Signature Date