Henry David Thoreau ElementarySafety Patrol
Introduction Letter
Dear Students and Parents,
Welcome to the 2023-2024 school year! Thoreau Elementary is looking for students 10 years of age and up to join Safety Patrol. Safety Patrol is a fun and essential job at our school to help keep our students and campus safe. Please consider the following items when joining safety patrol:
- Participation – Monday through Friday during the week your student’s squad is on duty.
- Time Commitment – 9:00-9:15 AM to 3:50-4:00 PM (before and after school) / 2:30 PM on Wednesdays
- Students are dismissed from class 5 minutes early at the end of the day set up.
- If you have conflicts (band, orchestra, sports, clubs) please note on the application. Conflicts can be worked around.
- Responsibility – Students will be serving our school community while helping others and leading by example.
In this packet you will find LWSD required forms to apply for safety patrol. Please complete and turn in applications to the office. Students with complete applications will be invited to begin training. If you have any questions, please feel free to email us. Thank you, and we look forward to another great year!
Sincerely,
Jordan Dickinson & Nancy Holden
Safety Patrol Supervisors
Student Application
Resource
Safety Patrol Application
Name:
Date:
Teacher:
Grade:
Age:
Why would you like to be a patrol member?
What skills and/or experiences do you have that would make you a good patrol member?
Please list any possible scheduling conflicts you might have: (i.e. Sports, Band, Orchestra, or Choir)
List two friends you would like to be with on a squad. We will do our best to honor this request.
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Teacher Recommendation:
Teacher Signature:
_______________________________________________________________
Thank you for your interest in keeping our students and school safe!
District Permission Slip
Resource
Lake Washington School District #414
Parent / Guardian Safety Patrol
Permission / Informed Consent Form
I hereby give my permission for _____________________________________, who attends Thoreau Elementary to be a member of the school Safety Patrol for the 2023-2024 school year.
As the parent/ guardian of the above-named child, I acknowledge that being a school safety patrol member entails known and unanticipated risks. Students are stationed in close proximity to vehicular traffic, and there is always a chance of physical or emotional injury. A school safety patrol member is also exposed to standing, walking and being outdoors in the sun and inclement weather. The school district will provide training and has purchased student accident insurance for all safety patrol members while at their post performing school safety patrol duties.
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In the event of an accident or illness, I understand that every reasonable effort will be made to contact the parent immediately. However, if I am not available, I authorize the school district to secure emergency medical care, as needed. As Parent or legal Guardian, I authorize a qualified physician to examine the above named student and in the event of an injury to administer emergency care and arrange for any consultation by a specialist, including a surgeon, as deemed necessary to insure proper care. I certify that my child has no medical or physical conditions that could interfere with his/her safety while serving as a member of the School Safety Patrol.
Student Address:______________________________________________________________
Student Home Phone#:____________________________ Date of Birth:_________________
In the event of an emergency (injury, illness) the following person must be notified in case the parent / guardian cannot be contacted:
Name_____________________________________ Phone:___________________________
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As the parent / guardian of the above named student patrol candidate I have read the information and understand that the school district will make every reasonable effort to provide proper training and supervision for my child in his/her service as a member of the School Safety Patrol. I am fully aware of any special dangers and risks inherent in participating in this activity, including physical injury and other consequences arising from these activities, Name of Parent or Guardian:____________________________________________________ Signature:____________________________________________________________________ Date:____________________________________ Daytime Phone:______________________