Parent/Guardian Permission Form Information



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Date28.05.2018
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Parent/Guardian Permission Form Information
As the parent/guardian of a student who is eligible to participate in the Real Care® Parenting Program, I have read and understand the following:

The Real Care® Parenting Program will require my student to be the sole caretaker of the Realityworks Infant Simulator, whose sounds and behaviors replicate those of an infant. The infant simulator requires care throughout the day and night. When Baby cries, it will be the responsibility of my student to attend to Baby’s needs. Baby’s crying and need for care may cause my student to lose sleep, and may possibly disturb other family members.



The Realityworks infant simulators are school property. If Baby is abused, damaged, or lost while in my student’s care, I may be held responsible for repair or replacement costs. Charges that may be assessed are:

Car Seat: $50

Baby: $400

Bottle/Cap: $7/$5

Diaper: $10

Diaper Bag: $20

ID: $10



NOTE: If permission slip is due:__________________. Student is automatically given the Baby Simulation Alternative Assignment to complete for credit if this is not received by _____________.
To participate in the Realcare® Parenting Program and receive full credit for performance, each student must care for the baby for the full 72 hours; including Sunday night (with the exception of necessary daytime *quiet times). If this is not the right option for your student, please select the Alternative Assignment.
*Quiet Times: Students will be allowed to have baby “quiet times” when they have mandatory events and activities to attend during the weekend. Quiet times total must not exceed 9 hours; if quiet times exceed 9 hours, please select the alternative assignment. Quiet times must start and end on the hour; for example 6:00pm to 7:00pm. There are three blocks available to set aside quiet time. Therefore the quiet times of 9 hours can only be grouped into three different times.
Real Care Baby Simulation Permission Slip

The students may complete their parenting experience during the designated periods that will be posted in the room for them to sign up when they have returned this sheet.

The possible weekend dates are as follows:

  • – (Returned to 2nd hour on this date) – (Returned to 2nd hour on this date)

  • – (Returned to 2nd hour on this date)



No, I do not wish my son/daughter to participate in the Real Care® Parenting Program. I understand that if I do not allow my student to participate in this project, he/she will not receive a lower grade because of my refusal. I understand that an assignment requiring an equal amount of work will be given as a substitute for this project.


Having read all of the above, I agree to allow my son/daughter to participate in the Real Care® Parenting Program.


Name of Student: _________________________________
Parent Signature: ___________________________________________________

Dear Parents and Family,


Our school is fortunate to have the Reality Works Real Care® Parenting Program. I hope each of you will take full advantage of the experience this program may offer to the whole family.
The core of the program is a parenting simulation using the Real Care® infant simulator. The parenting simulation is designed to help young adults understand three important facts about infants: (1) Infants’ demands are unpredictable and must be met promptly; (2) Infants require a great deal of time and attention; (3) Infants change a parent’s life profoundly. The program helps young adults explore physical, emotional, social, and financial consequences of parenthood.
A small computer inside Baby is programmed to follow actual schedules of 15 different newborns. Each day, Baby will be on a different schedule. Baby will cry and need to be fed, burped, rocked, and have its diapers changed. Baby may need your student to care for it at inconvenient times, including when they are sleeping.
Your student will be graded on learning how to keep Baby happy, their understanding of the full-time commitment of child care, the care and condition of Baby and supplies, and returning everything to school on time. Incidences of neglect, head support failure, shaking, rough handling, wrong position, no diaper, and other functions are recorded by Baby’s computer and will lower your student’s grade. Some of these behaviors will produce intense crying which can be stopped by rocking Baby.
Your student will wear a waterproof, hospital-type wristband with a unique ID that must be present whenever your student is caring for Baby. Without the ID, Baby will not accept care. The wristband and ID must be in good condition and still on your student’s wrist when Baby is returned.
Although the Baby may disrupt your household for a few days, it is my hope that you will agree that the lessons learned far outweigh a few days of inconvenience. It will be your child’s responsibility to keep Baby safe and cared for. You can help by providing emotional support and treating Baby as if it was real. Some ideas may be to help make arrangements for the Baby in advance, be a coach for this event, or call Baby by a given name. Offer advice, but remember your student should do the actual work of caring for Baby.
I will give students the possible dates for the simulation, and your son/daughter will need you to help them choose the most convenient date offered. I will post these dates and your student may sign up when they return the attached sheet with your signature.
If you have any questions or concerns, please contact me at Colleen.ramirez@pccsmail.net.
Sincerely,
Colleen Ramirez

Life Management Educator




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