Attend Parent/Teacher Conferences and Student Award ceremonies as scheduled throughout the year. Signature of Parent or Legal Guardian Date Dominion Academy Representative DOMINION ACADEMY Policies, Regulations, and Notices Behavior Support and Management Acknowledgment Last Review: 05/22/15 BEHAVIOR SUPPORT AND MANAGEMENT ACKNOWLEDGMENT STUDENT’S NAME: Birth date: Dominion Academy believes in a culture that promotes respect, healing, and positive behavior, and provides individuals with the support they need to manage their own behaviors. Dominion Academy has a Positive Behavior Intervention and Support (PBIS) that serves as the foundation for our daily structure and supervision. Dominion Academy also uses Therapeutic Options of Virginia (TOVA) as a crisis prevention and intervention model for our program. It assists in preventing crisis from occurring, de-escalating, potential crisis, managing acute physical behavior, reducing potential and actual injury to young people and staff, teaching young people positive coping skills and helps to create a learning organization. Our behavior management system and therapeutic crisis intervention procedures are approved by our licensing agencies. Please sign below to confirm the Dominion Academy behavioral support and management procedures were reviewed with you. Date Signature of Parent or Guardian DOMINION ACADEMY Policies, Regulations, and Notices Permission for Participation in Family Life Education Last Review: 05/22/15 Permission for Participation in Family Life Education STUDENT’S NAME DATE I hereby give permission for the above named student to participate in Family Life Education that is part of the health curriculum offered at Dominion Academy. Please check below.
