El Dorado Safety Patrols

El Dorado Safety Patrols

School Safety Patrol Application for El Dorado Elementary School Applicant

Student Name: ______Current Grade Level: ______

Current Teacher: ______

Directions:

Complete and return application and permission slip to Coach Turner or Coach Norman.

* You need to write your name on each page.

*Answer each and every question to the best of your ability.

*Please know that turning in an application does not guarantee a position as a patrol.

*Duty of a Patrol:

The patrol’s job is to remind students of safety rules and to guide them in safe crossing procedures. Patrols receive instructions in guidelines and procedures during their training and regular patrol meetings.

Duties of all patrols are listed below.

• Be proactive, set a good example, and encourage other students to also observe safety rules at all times.

• Report for duty on time with proper equipment.

• Know and help enforce “fairly” all walking regulations.

• Report to the patrol sponsor any problems as needed.

• Provide other assistance to drivers or crossing guards as requested.

• Attend and participate in all patrol meetings and training sessions as needed.

El Dorado Safety Patrol Application

Safety Patrol Applicant Full Name: ______

Home Address: ______

Phone Number: ______

Current Grade Level: ______Current Teacher: ______

How long have you attended El Dorado Elementary School? ______

Short Answer Responses:

Why do you want to be a safety patrol? ______

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What is your definition of a leader?

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Student Name: ______

A safety patrol serves as a positive role model in the community both during school as well as away from school. Please give an example of how you are a positiverole model for others.

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Another patrol asks some students, who happen to be your friends, to quiet down

becausethey are being too loud. The students, your friends, laugh at the request and ignore the patrol. What do you do?

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How will you enforce our school wide expectations – Be Respectful.Be Responsible. Be Safe? How can you influence others to be leaders?

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Student Name: ______

PARENT SECTION:

Parent’s Name (Printed): ______

Parent’s Signature: ______

Do you recommend your child be considered as a patrol? _____

Please reasons supporting your recommendation:

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I am usually a: _____ Bus rider _____ Car rider _____ Walker

I would prefer: _____ AM Duty _____PM Duty _____ both AM and PM duty

TEACHER SECTION: Please have your teacher initial each Eligibility Criteria.

Eligibility Criteria: ___ E or S in Work Habits

___ E or S in Conduct

___ passing academic courses

Classroom Teacher’s Name (Printed): ______

Classroom Teacher’s Signature: ______

Do you recommend this child be considered as a patrol? _____

Please reasons supporting your recommendation: ______