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REMEDIATION COURSE PERMISSION FORM 20102011

Student Name :

Student ID #

Course to be taken:

Course:

Semester:

Course:

Semester:

School (if not taking it at Jones):

Session:

Contact Person, Phone, Email: (This is the person who registers you for the course)

Teacher/professor, Phone, Email: (This is the person who teaches the course)

Student statement and signature: I understand that it is my responsibility to learn all policies and procedures for this class, attend all class sessions, complete all work on time, successfully pass, and deliver copies of my transcript to my counselor and the JCP Director of Student Services. I also understand that CPS and JCP cannot be responsible for my behavior or my safety if and when I am attending an offsite class.

Signed and dated:

Parent Guardian statement and signature: I understand that it is my student’s responsibility to learn all policies and procedures for this class, attend all class sessions, complete all work on time, successfully pass, and deliver copies of the transcript to the counselor and the JCP Director of Student Services. I also understand that CPS and JCP cannot be responsible for my child’s behavior or safety if and when attending an offsite class.

Signed and dated:

JCP Counselor:

JCP Assistant Principal:

Comments: For Office Use Only

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