STUDENT SAFETY AGREEMENT - North Buncombe Middle School
Buncombe County Schools
Career and Technical Education
2021-2022
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Email *
STUDENT SAFETY AGREEMENT
(The completion of this form is mandatory to participate in CTE labs)
Student First Name *
Student Last Name *
CTE Teacher/Course (check all CTE teachers you have this year) *
Required
Select the PowerSchool course number for the FIRST CTE teacher you have.  ASK for help, if needed. *
The above-named student is enrolled in a Career and Technical Education (“CTE”) course offered by Buncombe County Schools.  As a part of the instructional process and learning experience, he/she will be expected to use equipment (including power equipment and/or motorized vehicles) and materials, providing that the parent(s)/guardian(s) gives written permission. At the beginning of each course, the CTE teacher will provide proper instruction, both in the use of the equipment and materials and in correct safety procedures before the student will be allowed to use any equipment and materials.  Each CTE teacher will test every student in the safe use of the equipment and materials for the class in which he/she are enrolled.                   *
As the student I agree
The student must assume responsibility for all safe practices as set forth by the teacher. In addition, every student must agree to the following:
I will follow all safety rules for the course and following the teacher’s instruction.
I will behave in a proper manner in accordance with classroom rules.
I will never use equipment or materials without first having the expressed permission from the teacher.
I will never use equipment or materials unless I have been instructed in its use.
I will never enter any shop/lab area before I have passed a safety test with a grade of 100%.
I will immediately report any and all accidents or injuries to the teacher immediately.
No cell phones or similar devices allowed in the shop/active lab area.
I have reviewed this document and I understand that I am fully bound by its content. I further understand that if I do not follow the teacher’s instructions and safety guidelines as established by the teacher in the classroom and in this document, I may be prohibited from using the necessary class equipment and materials which could adversely affect my overall grade in the class.
Student Allergies/Health concerns (optional)
Student Signature (type your name) *
Student Email (school email) *
Parent/Guardian Signature (Type your name) *
Parent/Guardian Email *
Parent/Guardian daytime Phone Number *
By clicking on the "I agree", you as the student's Parent/Guardian are agreeing to allow the above-named student to use all equipment and materials necessary in carrying out the requirements of this course. *
Required
Secondary Parent/Guardian Name (optional)
Their Email
Their Phone Number
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