Implementation Statement and Signature Page

September 15, 2006

To all Palmer High School students and parent/guardians:

Recently, the Palmer School Committee approved a new Breathalyzer Policy and Protocol for Breathalyzer Testing as an addendum to the 2006-07 Student Handbook.  Please familiarize yourselves with this addition.  Its purpose is to prevent and deter alcohol use by students and guests on school grounds and for extra-curricular activities.  It allows the administration to better support the district’s alcohol policy which is explained in detail on Page No. 52 of the Student Handbook.  In order for a student to be eligible to attend extra-curricular activities (dances, the Prom, optional field trips, etc.) this signature page must be signed by both parent and student.  This is required in order to ensure all parties have received, read, and understood all aspects of the Breathalyzer Protocol.

In future years, the Breathalyzer Protocol will simply be part of the Student Handbook, and the usual signature procedures will remain in effect.

SECTION I: FOR PARENTS/GUARDIANS

Your signature below indicates your receipt and understanding of the Breathalyzer Protocol as an addendum to the 2006-07 Student Handbook.

Print Student’s Name: _____________________________________________

Signature of Parent/Guardian: _______________________________________

Date: ________________

SECTION II: FOR STUDENTS

I have read and agree to comply with the rules of the Breathalyzer Protocol.

Signature of Student: ______________________________________________

Date: ________________