Education Service Center, Region 20
Head Start Program
Family Partnership Agreement
Child’s Name:
Parent/Guardian’s Name:
White Copy – Child File Yellow Copy – Parent/Guardian
March 2017/CM
Education Service Center, Region 20
Head Start Program
Parent/Guardian
1. I agree to learn as much as possible about the Program, take part in major policy decisions, and encourage other parents to participate. I will make every effort to attend Parent Committee Meetings and training opportunities.
2. I agree to work with staff in a cooperative way in order to ensure the health of my child. This includes efforts in getting medical insurance and the completion of any medical or dental follow-up services. (Such as physical and dental exams, blood lab work, etc.)
3. I understand that attendance is important for school success. I agree to send my child daily and follow the school arrival/dismissal schedule. If my child is going to be absent from school, I will contact the school to notify them of the absence.
4. I agree to communicate my family needs to the Family Services Associates to ensure the well-being of my child/family.
5. I will make every effort to set and reach my short-term goals and keep Family Services updated on the progress I have made in reaching my goals.
6. I agree to follow the Parent Volunteer Training procedures/guidelines in order to volunteer in the program.
7. I agree to participate in two home visits and two parent-teacher conferences.
8. Parent option: ______
______
______
Parent/Guardian Signature Date
Family Service Associate
1. I agree to educate the Parent/Guardian on the Policies and Procedures of the program and to encourage the Parent/Guardian to become involved in Program Governance activities and training opportunities.
2. I agree to support the Parent/Guardian in the referral process to establish a medical/dental home and continuing the health services for their child. I will also follow up with parent on physical and dental exams, lab work, and any other health related services.
3. I agree to keep daily attendance records and provide the necessary support to ensure the child’s regular attendance. I will contact parents/guardians within the first hour of school if the parent has not contacted the school about the child’s absence.
4. I agree to assist the family by helping them utilize available community agencies.
5. I will assist the Parent/Guardian work towards their goals through encouragement, ongoing contact and referrals to community resources that support individual family goals.
6. I agree to encourage the Parent/Guardian
to become a Head Start volunteer and to treat the Parent/ Guardian with respect and dignity so that they feel comfortable and needed as a volunteer.
7. I agree to work with the Parent/Guardian to schedule home visits and parent-teacher conferences at a convenient time for the parent.
8. Parent Need:______
______
______
Family Service Associate Signature Date
White Copy – Child File Yellow Copy – Parent/Guardian
March 2017/CM