|
 Boy Scouts of America FIRE
SAFETY
Merit Badge |
|
This page
lists the requirements for this merit badge, a work sheet that
includes where you can find the information within this website.
Also included at the bottom of this page are various web links
to gather more information pertaining to this merit badge.
For a printable MS Word version of the Merit Badge requirements,
click here.
For a PDF version click
here.
For a printable MS Word version of the Merit Badge Work Sheet,
click here.
For a PDF version click here.
For a printable MS Word version of the Home Fire Safety Survey,
click here.
For a PDF version, click here.
To go to the worksheet on this page
click here.
To go to the reference links click
here.
|
|
1) Do the following: |
|
A) Demonstrate
the technique of stop, drop, roll, and cool. Explain how burn
injuries can be prevented. |
|
B) List the
most frequent causes of burn injuries.
|
|
|
|
2) Explain the
chemistry and physics of fire. Name the parts of the fire
tetrahedron. Explain why vapors are important to the burning
process. Name the products of combustion. Give an example of
how fire grows and what happens. |
|
|
|
3) Name the
most frequent causes of fire in the home and give examples of
ways it can be prevented. |
|
|
|
4) Do the
following: |
|
A) Explain the
role of human behavior in the arson problem in this country. |
|
B) List the
actions that cause seasonal fires and explain how these fires
can be prevented. |
|
|
|
5) List common
circumstances that cause holiday-related fires and explain how
these fires can be prevented. |
|
|
|
6) Conduct a
home safety survey with the help of an adult. Then do the
following: |
|
A) Draw a home
fire escape plan, create a home fire drill schedule, and conduct
a home fire drill. |
|
B) Test a smoke
alarm and demonstrate regular maintenance of a smoke alarm.
(Note: Establish a pattern. For example, change smoke alarm
batteries at least once a year -- on the same birthday or
holiday each year, or when you set your clocks forward for
daylight savings time in the spring, or back in the fall for
return to standard time. |
|
C) Explain what
to do when you smell gas and when you smell smoke. |
|
D) Explain how
you would report a fire alarm. |
|
E) Explain what
fire safety equipment can be found in public buildings. |
|
F) Explain who
should use fire extinguishers and when these devices can be
used. |
|
G) Explain how
to extinguish a grease pan fire. |
|
H) Explain what
fire safety precautions you should take when you are in a public
building. |
|
|
|
7) Do the following: |
|
A) Demonstrate
lighting a match safely. |
|
B) Demonstrate
the safe way to start a charcoal fire. |
|
C) Demonstrate
the safe way to melt wax. |
|
|
|
8) Explain the
difference between combustible and noncombustible liquids and
between combustible and noncombustible fabrics. |
|
|
|
9) Do the
following: |
|
A) Demonstrate
the safe way to fuel a lawn mower. |
|
B) Demonstrate
the safety factors, such as proper ventilation, for auxiliary
heating devices and the proper way to fuel such devices. |
|
|
|
10) Do the following: |
|
A) Explain the
cost of outdoor and wildland fires and how to prevent them. |
|
B) Demonstrate
setting up and putting out a cooking fire. |
|
C) Demonstrate
using a camp-stove and lantern. |
|
D) Explain how
to set up a campsite safe from fire. |
|
|
|
11) Visit a
fire station. Identify the types of fire trucks. Find out
about the fire prevention activities in your community. |
|
|
|
12) Choose a
fire-safety-related career that interests you and describe the
level of education required and responsibilities of a person in
that position. Tell why this position interests you. |
|
|
|
Return to top of this page |
|
Fire Safety
Work sheet |
|
Requirement 1 |
|
___ Demonstrate
the technique of stop, drop, roll, and cool.
(Pamphlet Page 45),
See Babysitter information page
or See Burn information page |
|
Explain how
burn injuries can be prevented:
See Burn information page
___________________________________________________________________________________________________________________________________________ |
|
|
|
List the most frequent causes of burn injuries:
See Burn information page |
|
Cause:
____________________________________________________________________________________________________________________________________
|
|
Cause:
____________________________________________________________________________________________________________________________________
|
|
Cause:
____________________________________________________________________________________________________________________________________
|
|
Requirement 2 |
|
|
|
Explain the
chemistry and physics of fire: (Pamphlet Page 8)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________ |
|
Name the parts
of the fire tetrahedron: (Pamphlet Page 10)
1: _________________________ 2:
_________________________ 3: _________________________
4: _________________________ |
|
Why are vapors
important to the burning process? (Pamphlet Page 10)
___________________________________________________________________________________________________________________________________________ |
|
Name the products of combustion: (Pamphlet Page 11)
1: _________________________ 2:
_________________________ 3: _________________________ |
|
Give an example
of how fire grows and what happens:
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 3 |
|
Name the most frequent causes of fire in the home and give
examples of ways it can be prevented.
See Home Safety page
(Pamphlet Page 13 through 18)
Cause #1: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Cause #2: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Cause #3: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Cause #4: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Cause #5: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 4 |
|
Explain the role of human behavior in the arson problem in this
country: (Pamphlet Page 18)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
List the actions that cause seasonal fires and explain how these
fires can be prevented: (Pamphlet Page 19 through 22)
December - February:
______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
March - May: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
June - August: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
September - November:
______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 5 |
|
List common circumstances that cause holiday-related fires and
explain how these fires can be prevented:
See Holiday Safety page
(Pamphlet Page 19 through 22)
December - February:
______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
March - May: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
June - August: ______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
September - November:
______________________________________________
Prevention:
__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 6 |
|
__ At the bottom of this worksheet you will find a Home Safety
Survey. Complete the survey with an adult before moving on.
After completing the safety survey, use the area below to draw a
home fire escape plan. (Pamphlet Page 28 through 31) Follow the layout and include everything
described in your merit badge pamphlet.
See Home Safety page
Using the information given in the merit badge pamphlet, create
a home fire drill schedule. (Pamphlet Page 31 )
See Home
Safety page
Use this space or attach an additional
piece of paper to the worksheet:
 Return to top of this page
|
|
__ Conduct a home fire drill See
Home Safety page
Describe how your fire drill turned out and identify any part of
your fire drill that needs more practice:
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
__ Test a smoke alarm. See Smoke
Detector page (Pamphlet Page 32 through 34)
Describe regular maintenance of a smoke alarm:
_______________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Establish a pattern for testing your smoke alarms. When
and how
often have you decided to test your smoke alarms?
See Smoke Detector page
(Pamphlet Page 34)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain what to do when you smell natural gas: (Pamphlet
Page
43)________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain what to do when you smell smoke:
See Fire Safety page
(Pamphlet Page
42)___________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain how you would report a fire alarm: (Pamphlet Page
35)___________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain what fire safety equipment can be found in public
buildings: (Pamphlet Page
36)_________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain who should use fire extinguishers:
See Fire Extinguisher page
(Pamphlet Page 36 and 37)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain when fire extinguishers should be used:
See Fire Extinguisher page
(Pamphlet Page 36 and 37)
__________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain how to extinguish a grease pan fire:
See Home Safety page
(Pamphlet Page 37 and 38)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain what fire safety precautions you should take when you
are in a public building: See Hotel
Safety page
(Pamphlet Page 36)
__________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 7 |
|
With your counselor present, demonstrate the following:
__ Light a match safely. (Pamphlet Page 48)
__ Safely start a charcoal fire.( Pamphlet Page 48 and 49)
__ Safely melt wax. (Pamphlet Page 50)
|
|
Requirement 8 |
|
Explain the difference between combustible and noncombustible
liquids: (Pamphlet Page 52 through 54)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain the difference between combustible and noncombustible
fabrics: (Pamphlet Page 52 through 54)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 9 |
|
With your counselor present:
__ Demonstrate the safe way to fuel a lawn mower. (Pamphlet Page
55)
__ Demonstrate the safety factors, such as proper ventilation,
for auxiliary heating devices. (Pamphlet Page 51 through 52)
__ Demonstrate the proper way to fuel auxiliary heating devices.
(Pamphlet Page 52 through 54)
|
|
Requirement 10 |
|
Explain the cost of outdoor and wildland fires: (Pamphlet Page
58)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Explain how to prevent outdoor and wildland fires: (Pamphlet
Page 59 through 60)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
__ Demonstrate setting up and putting out a cooking fire.
See Home Safety page (Pamphlet
Page 53 through 64)
__ Demonstrate using a camp-stove and lantern (Pamphlet
Page 61 through 62)
Explain how to set up a campsite safe from a fire: (Pamphlet
Page 59)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 11 |
|
__ Visit a fire station
What types of truck did you see and identify during your visit
to the fire station? (Pamphlet Page 68) See apparatus page
for similar types of trucks (Maybe different in your city)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
What fire prevention activities are going on in your community?
(Pamphlet Page 66 through 67) See Special Programs page,
Code Enforcement page,
Public Education page
and Fire Prevention page
(Maybe different in your city)
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
|
|
Requirement 12 |
|
Choose a fire-safety-related career that interests you:
___________________________________________________________________________________________________
Describe the level of education required of a person in that
position: (Pamphlet Page 66 through 67), See Hiring page (Maybe
different in your city)
___________________________________________________________________________________________________________________________________________
Describe the responsibilities of a person in that position:
(Pamphlet Page 66 through 67), See Hiring page (Maybe different in
your city)
___________________________________________________________________________________________________________________________________________
Tell why this position interests you:
_________________________________________________________________________________________________________________
|
| Return to top of
this page |
|
Home
Safety Survey |
|
Together with your parents and other members of your family, use
this checklist to check the safety of your house. Not every
question will apply to your home, but most probably will. For
each question that is answered with a yes, put a number 1 in the
score column. After going through the entire list, add up your
score. Where you have answered no, attempt to correct the
hazards or change the actions. After a few days of making
corrections, go through the list again and see how much your
score has improved. |
|
Fire
Safety Checklist |
|
Score |
|
|
|
|
|
Matches |
|
|
|
____ |
Are
matches kept where young children can not get hold of
them? |
__
Yes |
__ No |
|
____ |
Are
strike-anywhere matches kept in metal containers? |
__
Yes |
__ No |
|
____ |
Are all
matches kept away from sources of heat such as stoves
and heaters? |
__
Yes |
__ No |
|
____ |
Do you
see to it that all matches and smoking materials are out
before they are disposed of? |
__
Yes |
__ No |
|
____ |
Are
there plenty of unburnable deep-dish ashtrays in all
rooms of the house? |
__
Yes |
__ No |
|
____ |
Is "no
smoking in bed" a rule of the house? |
__
Yes |
__ No |
|
____ |
is a
responsible person left with the children when the
parents go out, even for a little while? |
__
Yes |
__ No |
|
____ |
Are
baby-sitters instructed carefully on what to do in case
of fire? |
__
Yes |
__ No |
|
|
|
|
|
|
|
Smoke
Detectors |
|
|
|
____ |
Are the
smoke detectors in your home installed properly? |
__
Yes |
__ No |
|
____ |
Are
smoke detectors located in all sleeping areas of your
home and on every level? |
__
Yes |
__ No |
|
____ |
Are all
smoke detectors tested at least once a month? |
__
Yes |
__ No |
|
____ |
When
the smoke detector sounds, does everyone know to get out
of the house immediately? |
__
Yes |
__ No |
|
____ |
If a
smoke detector fails to operate when tested, is it fixed
immediately? |
__
Yes |
__ No |
|
____ |
Do you
change the batteries in your smoke alarms at least once
a year, such as on a birthday or holiday, |
|
|
|
|
or when
you set your clocks forward in the spring for daylight
savings time, or back in the fall for return |
|
|
|
|
to
standard time? |
__
Yes |
__ No |
|
|
|
|
|
|
|
Electrical Hazards |
|
|
|
____ |
Are
only qualified electricians allowed to install or extend
wiring? |
__
Yes |
__ No |
|
____ |
When
you buy electrical equipment - extension cords,
appliances, TV sets, and all other devices - do |
|
|
|
|
you
always make sure it has been tested at an approved
facility, such as Underwriters' Laboratories? |
__
Yes |
__ No |
|
____ |
Are
enough electrical outlets in each room to avoid the need
for multiple attachment plugs and long |
|
|
|
|
extension cords? |
__
Yes |
__ No |
|
____ |
Are
there special circuits for heavy-duty appliances such as
stoves, air conditioners, and clothes dryers? |
__
Yes |
__ No |
|
____ |
On the
household lighting circuit, are the proper fuses or
circuit-breakers used? |
__
Yes |
__ No |
|
____ |
Are all
extension cords in the open - not run under rugs, over
hooks, or through partitions or door openings? |
__
Yes |
__ No |
|
|
|
|
|
|
|
Storage
And Flammable Liquids |
|
|
|
____ |
Are
your basement, closets, and attic kept free of rubbish,
oily rags, flammable liquids, large stacks of paper,
etc., and is necessary storage kept in orderly fashion? |
__
Yes |
__ No |
|
____ |
After
oily polishing rags are used, are they destroyed or else
placed in covered metal cans in a metal cabinet in the
garage? |
__
Yes |
__ No |
|
|
|
|
|
|
____ |
If you
store paint, varnish, or other flammable liquids, are
the containers metal, tightly closed, and kept in a
metal cabinet in the garage? |
__
Yes |
__ No |
|
____ |
If you
keep gasoline for use in a power mower or outboard
motor, is it stored in an approved metal |
|
|
|
|
can
with a self-closing cap on the openings? |
__
Yes |
__ No |
|
____ |
If you
burn coal, are ashes put in metal containers, clear of
wood floors or partitions? |
__
Yes |
__ No |
|
____ |
Has
everyone in the family been warned never to use
gasoline, benzine, or other flammable liquids for
cleaning clothes, furnishings, or floors? |
__
Yes |
__ No |
|
____ |
If your
garage is attached to the house or in the basement, is
it separated from the living area by cutoff walls with a
tight-fitting door? |
__
Yes |
__ No |
|
|
|
|
|
|
|
Heating
And Cooking |
|
|
|
____ |
IF you
use oil heat, is the equipment listed by Underwriters'
Laboratories? |
__
Yes |
__ No |
|
____ |
If you
use gas heat, is the equipment listed by Underwriter's
Laboratories or the American Gas Association
Laboratories? |
__
Yes |
__ No |
|
____ |
If your
heating system is oil or coal, do you have it inspected
and serviced before each season begins? |
__
Yes |
__ No |
|
____ |
If your
heating system is gas, is it regularly checked and
serviced? |
__
Yes |
__ No |
|
____ |
Are all
chimneys, gas and smoke pipes, and other flue
connections inspected each fall and cleaned and repaired
as necessary? |
__
Yes |
__ No |
|
____ |
Are
walls, ceilings, and partitions near heating and cooking
equipment either adequately separated from the sources
of heat or protected by noncombustible materials? |
__
Yes |
__ No |
|
____ |
Are
wood floors under space heaters or coal stoves protected
by insulation or ventilated air space? |
__
Yes |
__ No |
|
____ |
Is the
inside basement door at the head of the stairs tightly
fitted and kept closed at night? |
__
Yes |
__ No |
|
____ |
Is the
kitchen stove, including the oven and broiler, kept
clean of grease? |
__
Yes |
__ No |
|
____ |
Is the
kitchen exhaust fan kept clean of grease? |
__
Yes |
__ No |
|
____ |
Are
curtains arranged so as not to blow over stoves and
heaters? |
__
Yes |
__ No |
|
____ |
Are all
portable and space heaters set level and out of the way
of traffic? |
__
Yes |
__ No |
|
____ |
Are oil
and gas heaters, which use oxygen as they burn, properly
vented? Do you always keep a |
|
|
|
|
door or
window slightly open in any room where such a heater is
being used? |
__
Yes |
__ No |
|
____ |
Are the
fuel tanks of oil heaters refilled only by adults
outdoors and in daylight? |
__
Yes |
__ No |
|
____ |
Are the
gas connections for space heaters or other gas
appliances made of metal? |
__
Yes |
__ No |
|
____ |
Has
everyone in the family been warned never to use kerosene
or other flammable liquids to start a |
|
|
|
|
fire in
the fireplace or furnace? |
__
Yes |
__ No |
|
____ |
Is
every indoor fireplace equipped with a sturdy metal fire
screen? |
__
Yes |
__ No |
|
____ |
Are the
shutoff valves for gas appliances located on the rigid
metal gas pipeline where they can be |
|
|
|
|
reached
in case of trouble - and not on the appliance? |
__
Yes |
__ No |
|
____ |
Have
all electric, oil, or gas heaters been tested and listed
by a recognized testing laboratory such as |
|
|
|
|
Underwriters' Laboratories? |
|
|
|
|
|
|
|
|
|
Yard
Hazards |
|
|
|
____ |
Do you
keep your yard cleared of leaves, debris, and
combustible rubbish? |
__
Yes |
__ No |
|
____ |
In
areas where burning trash Is permitted, are trash and
refuse burned only in suitable outdoor |
|
|
|
|
incinerators and on sufficiently calm days? |
__
Yes |
__ No |
|
____ |
Is an
adult always present during the entire time trash or
leaves are being burned outdoors? |
__
Yes |
__ No |
|
____ |
Are
charcoal grills used only outdoors and lighted without
the use of liquid fuels? |
__
Yes |
__ No |
|
|
|
|
|
|
|
Holiday
Hazards |
|
|
|
____ |
Do you
have a save and sane Fourth of July by not using
fireworks? |
__
Yes |
__ No |
|
____ |
In
buying gift toys, do you insist on those that can't
cause fire, shock, or explosion? |
__
Yes |
__ No |
|
____ |
Is your
Christmas tree kept in water and thrown out when the
needles begin to fall? |
__
Yes |
__ No |
|
____ |
Is all
decorative lighting checked for frayed and loose
sockets? |
__
Yes |
__ No |
|
____ |
Is the
tree kept outside until you are ready to set it up? |
__
Yes |
__ No |
|
____ |
Is
there a switch away from the tree for turning the lights
on and off? |
__
Yes |
__ No |
|
____ |
Are
tree lights shut off whenever you go out or to bed? |
__
Yes |
__ No |
|
____ |
Are all
decorating materials noncombustible? |
__
Yes |
__ No |
|
____ |
Are
gift wrappings gathered up and disposed of promptly
after presents are opened? |
__
Yes |
__ No |
|
____ |
Are
candles placed so they cannot reach combustible
materials? |
__
Yes |
__ No |
|
____ |
Does
every family member know the proper procedure for
reporting a fire in your community, such |
|
|
|
|
as the
911 or other emergency number, or the location of the
neighborhood fire-alarm box? |
__
Yes |
__ No |
|
____ |
Does
every family member know how to call the fire
department? |
__
Yes |
__ No |
|
____ |
Did the
entire family take part in completing this checklist? |
__
Yes |
__ No |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Parents
Signature: _____________________________________________ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1st
SCORE TOTAL: __________ 2nd SCORE TOTAL:
__________ |
|
|
Return to top of this page |
|
|
