High School Registration Form - Camp Keep (Page 2 of 2) in pdf

Office of Christine Lizardi Frazier

Kern County Superintendent of Schools

Advocates for Children

KEEP HIGH SCHOOL COUNSELOR BEHAVIOR CONTRACT

KEEP is depending on you as a counselor. Please read, initial each statement, and sign at the bottom of this

contract. Turn this contract in with your registration form. Please note that your parent or guardian’s signature

is also required if you are under 18 years old.

As a counselor at KEEP I understand that:

______I will be assigned to specific responsibilities for 7-13 elementary students.

______I will be looked up to by these students which will require me to be an excellent role model at all times.

______I will be expected to follow all KEEP rules along with the students and I will support those rules. For

example, no cell phones, candy, soda or gum in front of the students.

______If a student is misbehaving or breaking a rule, I will be expected to take the student to his/her teacher or

a staff member.

______The KEEP staff and classroom teachers will be available 24 hours per day to assist and support me with

any situation I may encounter.

As a counselor at KEEP I verify that:

______I am physically able and willing to accompany the students on all hikes, up to six (6) miles per day with

elevation gains over 1000 feet.

As a counselor at KEEP I agree that:

______ I will not use inappropriate language during my KEEP week.

______ I will not hit, touch, or raise my voice to any person for any reason.

______ I will not use alcohol, tobacco products, or any illegal drugs during my KEEP week.

______ I will not discuss sexual or religious issues of any kind with the students, nor will I tolerate uncompli-

mentary remarks regarding one’s religious, gender, or ethnic group.

______ I will not permit teasing or bullying of students in my care.

______ I will treat all students with kindness, respect and dignity.

I have read the above counselor contract and understand my responsibilities as a KEEP counselor. I understand

that if I do not fulfill my KEEP responsibilities as stated above, I will be sent home.

____________________________________________________________ ____________________________

Please sign your full name

date

I understand that if my child does not fulfill his/her KEEP responsibilities as outlined above, the KEEP staff and

classroom teachers must dismiss him/her immediately and that I will be notified and expected to transport my

child home immediately.

____________________________________________________________ ____________________________

Parent/Guardian signature

date

(if counselor under 18 years)

GS:KP:10

Rev. 10/15

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High School Registration Form - Camp Keep Page 2