Parent Guardian Acknowledgement

Parent/Guardian Acknowledgement of Responsibility

This form is for parents/legal guardians of all students enrolled in Henry County Public Schools to ensure that they have received and reviewed the following important documents.

Student Name ____________________________________   Date of Birth _____________________

School _______________________________________________________________________________

Homeroom Teacher ________________________________                   Grade _________

I have received and reviewed each of the following:

1. Code of Student Conduct
2. A copy of 22.1-279.3 of the Code of Virginia that sets forth the duty of each parent of a student enrolled in a public school to assist the school in enforcing the standards of student conduct and compulsory attendance.
3. A copy of 22.1-254 of the Code of Virginia pertaining to the compulsory attendance law.
4. A copy of the Acceptable Use of Internet and Technologies Policy.
5. Acceptable Dress Code
6. School Bus Offenses
7. Homeless Education Rights
8. Student Directory Information

The Code of Student Conduct applies to students at all times and in the following locations:

• In school buildings or on school property
• At school-related and school-sponsored activities, on and off school property
• At bus stops, on buses, and in other school vehicles
• Off school property and outside school hours if the conduct reasonably forecasts a material and substantial disruption to the school system, adversely affects school discipline, or results in criminal charges or a conviction.

My signature acknowledges receipt of the above-listed documents. By signing this statement of receipt, I do not waive, but expressly reserve, my rights protected by the constitution or laws of the United States or Commonwealth of Virginia. I retain the right to express disagreement with a school’s or school division’s policies or decisions.

Print Parent/Legal Guardian/Eligible Student Name ___________________________________________

Signature of Parent/Legal Guardian* _________________________________________              _____________

                                                                                                                                                                                                                Date

Signature of Student Age 18 or above _______________________________________                 _____________

                                                                                                                                                                                                                Date

* Checking the box on the registration form to acknowledge receipt of the Code of Student Conduct stands in place of the parent signature.

Please return this form to your child’s homeroom teacher no later than August 17, 2019.