DFPS Parent Forms
Summer 2016
Student’s Last Name: ___________________Student’s First Name:______________ID# _________
*(use student’s legal names)
My child’s home school is: _________________________
Summer PASAR Parent Checklist
(Please initial each box)
I have received the Summer PASAR Parent Handbook and PASAR Operational Policies.
I give permission to Plano ISD/PASAR to take my child with his/her designated group to the City of
Plano Tejas Park (920 Bass Drive, Plano TX, 75025) located south of Rasor Elementary.
I authorize Plano ISD/PASAR to obtain emergency medical care and to transport my child for
emergency medical treatment.
My Child’s physician name address and phone are:
DR.: ______________________________________Phone: ________________________
Address, City and Zip: ______________________________________________________
Name of Medical Facility you prefer in case of an emergency: ________________________
I have turned in my child’s medical action plan(s) if applicable.
June 13 - July 8, 2016, I will provide lunch for my child that may/may not meet the FMNV (Federal
Minimal Nutrition Value) requirements by the Texas Department of Agriculture.
July 11 - August 5, 2016 lunch will be provided by Rose Food Service
I may choose to supply a snack for my child that may/may not meet FMNV (Federal Minimal
Nutrition Value). Snacks will be provided by PASAR. A snack list will posted at the PASAR front
desk.
I understand I will be given a permission slip for each field trip that I must sign and return to the
site manager.
My Child has immunization records at their home school.
I understand Summer PASAR will not participate in any swimming or water activities.
My child has permission to travel to the weekly field trips by Plano ISD school buses.
Yes
No
Parent/Guardian Signature:
________________________________________
________________________
Date
My Child will be brought to Summer PASAR by: Bus: ______ (because Rasor is my child’s home school) Parent /Guardian Drop Off: ______ Other: _______________________________________ Student’s Last Name: ___________________Student’s First Name:______________ID# _________
*(use student’s legal names)
My child’s home school is: _________________________
Licensing and Insurance Information The PISD Summer PASAR program at Rasor Elementary School will be licensed by the Texas Department of Family and
Protective Services (DFPS). A full-text copy of the Minimum Standard Rules for Licensed Child Care Centers is available
for review at http://www.dfps.state.tx.us/.
As a parent or guardian with a child enrolled in the summer PASAR program, you have the right to review all current
inspections conducted by the DFPS, the Fire Department, the Health Department, and any other inspections as may be
required for the operation of the summer PASAR program. To review these documents, please contact the PASAR
program director. From time to time the PASAR program is required to post such inspections in an obvious location for
parents to review. Should this be the case, the PASAR program director will post the appropriate inspections on the
bulletin board located nearest to the PASAR entrance of Rasor Elementary School.
Important Contact Information for Parents:
Texas Department of Family and Protective Services
550 East 15th Street
Suite 120
Plano, Texas 75074
469-229-6906
http://www.dfps.state.tx.us/
Texas Abuse/Neglect Hotline
(800) 252-5400
https://www.txabusehotline.org
Pursuant to the Texas Tort Claims Act, public school districts are entitled to sovereign immunity which protects districts
from liability for personal injury and negligence claims, with the exception of claims involving property damage, personal
injury, or death arising from the operation or use of a motor vehicle by a school district officer or employee. Therefore,
Plano ISD is not required to obtain, and will not obtain insurance in addition to standard District coverage for claims
and/or injuries that occur at the PISD Summer PASAR program.
_________________________________
Parent or Guardian Signature
_________________________________
Parent or Guardian Printed Name
_________________________________
Date
Student’s Last Name:_____________________ Student’s First name: __________________ID#:_________ * (use student’s legal names) Discipline and Guidance Policy for PISD- Summer PASAR
Name of Operation

 Discipline must be: (1) Individualized and consistent for each child; (2) Appropriate to the child’s level of understanding; and (3) Directed toward teaching the child acceptable behavior and self‐control.  A caregiver may only use positive methods of discipline and guidance that encourage self‐esteem, self‐control, and self‐direction, which include at least the following: (1) Using praise and encouragement of good behavior instead of focusing only upon unacceptable behavior; (2) Reminding a child of behavior expectations daily by using clear, positive statements; (3) Redirecting behavior using positive statements; and (4) Using brief supervised separation or time out from the group, when appropriate for the child’s age and development, which is limited to no more than one minute per year of the child’s age.  There must be no harsh, cruel, or unusual treatment of any child. The following types of discipline and guidance are prohibited: (1) Corporal punishment or threats of corporal punishment; (2) Punishment associated with food, naps, or toilet training; (3) Pinching, shaking, or biting a child; (4) Hitting a child with a hand or instrument; (5) Putting anything in or on a child’s mouth; (6) Humiliating, ridiculing, rejecting, or yelling at a child; (7) Subjecting a child to harsh, abusive, or profane language; (8) Placing a child in a locked or dark room, bathroom, or closet with the door closed; and (9) Requiring a child to remain silent or inactive for inappropriately long periods of time for the child’s age. Texas Administrative Code, Title 40, Chapters 746 and 747, Subchapters L, Discipline and Guidance
My signature verifies I have read and received a copy of this discipline and guidance policy. Signature Date household member of child‐care home Check one please: Parent TDPRS-CCL 06/02/03
employee/caregiver