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171450038100Amphitheater Public Schools Amphitheater On Campus Supervision 0Amphitheater Public Schools Amphitheater On Campus Supervision Governor Ducey’s Executive Order 2020-51 requires our district to provide supervision for students “…who need a place to go during the day…”. Parents who require this service must complete this form and return it to the school where their child is enrolled.Requesting Supervision Services for the Week of: ______Student Name (print): ______School: ______Grade Level: ______Address: ______Parents’ Names (print): ______Parents’ Phone Numbers: ______Emergency Contact Name: ______Emergency Contact Phone Number: ______Why does your child need this service?: (choose one or more) ___ Special Education Student ___ In Foster Care ___ No Internet Access at Home ___ Parents are First Responders ___ McKinney-Vento ___ Child Care Issues ___ English Language LearnerI have read and understand the Terms and Conditions for this service and agree to adhere to these rules.Parent Signature: _____________________________________________________________Parent Name (print): ______Date: ______ ................
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