Park Place Community Middle School 266
Park Place Community Middle School 266 31 New York Avenue, Brooklyn, NY, 11216 Tel: 718- 245-8766 Fax: 718- 245-8769
“Thinking Outside of the Box” Glenda Esperance
Brenda Lee
Principal
Assistant Principal
Comfort Dog Pilot
December 2016
Dear Parent, We are very excited to announce that our school will be participating in the NYC Department of Education’s comfort dog pilot initiative in partnership with the North Shore Animal League America. Peter Parker, a Golden Retriever Terrier Mix, has recently joined our school community. Parker is a small, friendly dog who loves being around children. Our school comfort dog will be included in classroom lessons on social-emotional learning, resiliency, and human-animal interaction. We would also like to provide your child with the chance to interact directly with our school comfort dog for more individualized social-emotional learning opportunities. For example, students who have counseling sessions would be offered the opportunity to interact with the comfort dog to help meet their counseling goals for socialemotional performance (e.g., socialization and communication). The comfort dog may also be used as part of our school’s crisis intervention protocols; examples of school-based crisis intervention may include behavioral crisis de-escalation and bereavement assistance. Please complete the following form to indicate whether or not you consent to have your child participate in classroom presentations with the school comfort dog, and/or to interact directly with our school comfort dog. We look forward to seeing the positive impact that (NAME OF DOG) will have on our school’s culture and climate. Sincerely,
Glenda Esperance Principal
____________________________________________________________________________________
PARENTAL CONSENT FOR COMFORT DOG PROGRAM Student’s Last Name: ________________________ Student’s First Name: ____________________ Student’s Official Class: ______________ Please check all that apply: ______
Yes, I consent for my child to be in classroom presentations with the school comfort dog.
______
No, I do not consent for my child to be in classroom presentations with the comfort dog.
______
Yes, I consent for my child to interact directly with the school comfort dog.
______
No, I do not consent for my child to interact with the school’s comfort dog for the following reason(s): ___________________________________________________________________________ ___________________________________________________________________________
Additional comments (if needed): _____________________________________________________________________________________ _____________________________________________________________________________________
______________________________ Print Name
______________________________ Signature
______________ Date
“Thinking Outside of the Box” Glenda Esperance
Brenda Lee
Principal
Assistant Principal
Comfort Dog Pilot
December 2016
Dear Parent, We are very excited to announce that our school will be participating in the NYC Department of Education’s comfort dog pilot initiative in partnership with the North Shore Animal League America. Peter Parker, a Golden Retriever Terrier Mix, has recently joined our school community. Parker is a small, friendly dog who loves being around children. Our school comfort dog will be included in classroom lessons on social-emotional learning, resiliency, and human-animal interaction. We would also like to provide your child with the chance to interact directly with our school comfort dog for more individualized social-emotional learning opportunities. For example, students who have counseling sessions would be offered the opportunity to interact with the comfort dog to help meet their counseling goals for socialemotional performance (e.g., socialization and communication). The comfort dog may also be used as part of our school’s crisis intervention protocols; examples of school-based crisis intervention may include behavioral crisis de-escalation and bereavement assistance. Please complete the following form to indicate whether or not you consent to have your child participate in classroom presentations with the school comfort dog, and/or to interact directly with our school comfort dog. We look forward to seeing the positive impact that (NAME OF DOG) will have on our school’s culture and climate. Sincerely,
Glenda Esperance Principal
____________________________________________________________________________________
PARENTAL CONSENT FOR COMFORT DOG PROGRAM Student’s Last Name: ________________________ Student’s First Name: ____________________ Student’s Official Class: ______________ Please check all that apply: ______
Yes, I consent for my child to be in classroom presentations with the school comfort dog.
______
No, I do not consent for my child to be in classroom presentations with the comfort dog.
______
Yes, I consent for my child to interact directly with the school comfort dog.
______
No, I do not consent for my child to interact with the school’s comfort dog for the following reason(s): ___________________________________________________________________________ ___________________________________________________________________________
Additional comments (if needed): _____________________________________________________________________________________ _____________________________________________________________________________________
______________________________ Print Name
______________________________ Signature
______________ Date
