DECKER SUMMER CAMP REGISTRATION PACKET 2014 CREATIVE ACTION RETURN TO THE FRONT OFFICE OR MR. HAYES BY 6/5
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- Samuel Moreno Reyes
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1 DECKER SUMMER CAMP Campers will double their fun by participating in both Campfire and Creative Action programs! 6/9/14-7/25/14* 8AM-3PM Open to all current Decker students and incoming 5 th graders *Camp is closed the week of July 4th CAMP FIRE Learn about the world around you and explore new territory with Camp fire! In Camp fire students will gain camping and outdoor skills, do hands-on environmental science, and learn about the natural world. Students will play games, do science experiments, watch cool videos, go on field trips, and so much more! CREATIVE ACTION Camp students will participate in Visual Arts as well as the FIlm class. Write, direct and star in your very own movie in Creative Action's Film Club! Use your creativity to make your mark on your community in Creative Action's Visual Arts Club! Free Breakfast, Lunch and Transportation provided! RETURN TO THE FRONT OFFICE OR MR. HAYES BY 6/5 REGISTRATION PACKET 2014
2 Registration Information Student Information First Name: Last Name: Gender: circle one Male Female Date of Birth: / / Grade: for year School: Transportation circle one Bus Car/Pick Up Student ID # Student T-Shirt Size: XS S M L XL See back for more info. *If your child is attending the Communities in Schools summer program for the first three weeks, he/she may join this Creative Action/Camp Fire camp for the second 3-week session. If this is the case, however, your child will participate in only one of the programs, not both. **If your child is attending Breakthrough or summer school, he/she will be unable to attend this Creative Action/Camp Fire program. Will your child attend the Communities in Schools summer program for the first three weeks? Yes No If yes, do you wish to be notified about available spots in the second 3-week session of our summer program (7/7/14-7/25/14)? Yes No Note: We expect full participation of all students in our programs. If your child is not going to be attending the program regularly for any reason, please contact the Site Coordinator at your child s campus prior to the start of programming. If your child misses more than 5 days, he/she may be removed from the program.
3 Parent/Guardian Information First Name: Relationship: Last Name: Mailing Address City: State: Zip: Cell Phone :( ) Work Phone :( ) Ext Parent/Guardian Information First Name: Relationship: Last Name: Mailing Address City: State: Zip: Cell Phone :( ) Work Phone :( ) Ext Emergency Contact/Authorized Pick-Ups Name: Phone :( ) Name: Phone :( )
4 Authorization for Emergency Care *** Please Print*** Please let us know if your child has any physical limitation or Food Allergies: Please list any medications that your child is taking: Please note that Site Coordinator are CPR & First Aid Certified, however, there is not a nurse on duty during the summer camps hours. We will call 911 for any medical emergencies Child s Physician: Phone :( ) Child s Dentist: Phone :( ) Illness: We urge to keep your children at home if they are ill, both for their sake and for the sake of other children. If a child is feeling ill during camp hours for a duration of 20 minutes or longer, or if the illness includes fever of or higher, vomiting or diarrhea, the site coordinator will contact the parent/guardian for immediate pickup. If the child has been exposed to or has a communicable disease, the staff should be notified at once. If the children have been exposed to a communicable disease during camp hours, we will notify the parents at once. Accident: If an accident should occur during the camp hours, the Site Coordinator will notify the parent/guardian at once. The staff member caring for the child will complete a written report of any accident considered serious, detailing the medical procedure that was followed. We require the parent/guardian to read and sign this document. If emergency treatment is warranted, the Site Coordinator will immediately notify the parent/guardian and the child will be transported by ambulance to the nearest medical facility, if necessary. Medication: Medication to be administered to your child by the Site Coordinator. Any medication to be administered to your child must: Be brought directly to the Site Coordinator by the parent or guardian. Be in the original container, labeled with the child s name, date, directions and physician s name. Be accompanied by clear written instructions and the time medication is to be given. The Site Coordinator will make every attempt to give medicine on time. It is helpful with a child notifies the Coordinator when medication is to be taken. If the medication is to go home with the child at the end of every day or week, it is the parent s responsibility to pick it up from the Coordinator. Signature of Parent or Guardian Date
5 Student ID Number Request Our agency will use your student's ID # in order to evaluate the effectiveness of our programs and/or interventions. We will also provide these ID #s to our funder, United Way, so that they can combine our outcomes with the outcomes of other programs they fund to evaluate across all of their initiatives. The organizations will submit student ID numbers for participants, as a group, into the Student Aggregate Report system to generate group reports on our participants' attendance, discipline and academic achievement. We will not receive back individual information about your student. Media Release Form Media Release I fully understand that public presentations of my child s work is a critical component of this program, including, but not limited to: display of art work, live or videotaped performances, sound recordings, etc. Also, it may be necessary for program staff to photograph or videotape program youth to advertise the program or for other purposes. Yes, I give permission for program staff to photograph or videotape my child. No, I do not give permission for program staff to photograph or videotape my child. Printed Name of Student: Printed Name of Parent or Guardian: Signature of Parent or Guardian :
6 DECKER CAMPAMENTO DE VERANO Estudiantes pasarán un verano divertido y participarán en los programas de Camp Fire y Creative Action. 6/9/14-7/25/14* 8AM-3PM *El campamento estará cerrado durante la semana de 4 de Julio. **Se pueden registrar todos estudiantes de grado 5 que asistirán a Decker escuela intermedia después del verano. CAMP FIRE Aprende sobre el mundo que te rodea y explora territorio nuevo con Camp Fire! En el programa estudiantes ganarán destrezas del yermo y de acampada, harán actividades de ciencia ambiental, y aprenderán del mundo natural. MATERIAS DE MATRICULACIÓN 2014 Estudiantes jugarán juegos, harán experimentos, verán videos bien chidos, irán por viajes de campo, y mucho más CREATIVE ACTION Estudiantes participarán en el programa de artes visuales y también la clase de película. Escribe, dirige, y actúa en su priopia película en el club de cine de Creative Action! Usa su creatividad para tener una influencia positiva en su comunidad en el club de arte visual de Creative Action. Desayuno, almuerzo, y transporte gratis! DEVUELVE ESTE PAQUETE A LA OFICINA SR. HAYES ANTES DE 4 DE JUNIO HENRY.HAYES@MANORISD.NET
7 Información de matriculación Información estudiantil Primer nombre: Apellido: Sexo circule uno: masculino femenino fecha de nacimiento: / / Grado del estudiante para el año Escuela: Transporte circule unoo: autobus coche ID estudiantil # tamaño de camiseta (circule uno): XS S M L XL *Si su hijo/a asistirá al programa de Communities in Schools (CIS) durante las primeras tres semanas del programa del verano, puede también participar en este programa de Decker durante la segunda sesión. Sin embargo, en este caso su hijo/a puede participar en sólo uno de los dos programas (Camp Fire o Creative Action). **Si su hijo/a asistirá al programa de Breakthrough o escuela de verano (SSI), no puede asistir a nuestro programa también. Asistirá su hijo/a al programa de Communities in Schools (CIS) durante las primeras tres semanas del verano? Sí No Si su hija/a participará en Communities in Schools (CIS), quiere recibir notificación de la oportunidad para que participe también en nuestro programa durante la segunda sesión del verano (7/7/14-7/25/14)? Sí No
8 Información del padre/guardian Primer nombre: Relación: apellido: correo electrónico: Domicilio Ciudad: estado: código postal: Teléfono celular :( ) Teléfono de trabajo :( ) Ext Información del padre/guardian Primer nombre: Relación: apellido: correo electrónico: Domicilio Ciudad: estado: código postal: Teléfono celular :( ) Teléfono de trabajo :( ) Ext Contacto de emergencia que puede levanter su niño/a Nombre: Teléfono :( ) Nombre: Teléfono :( ) Autorización para asistencia de emergencia *** Favor de escribir de impreso*** Por favor nos informa si tu niño tiene alguna limitación física o alergia de comida: Por favor enúmero algunos medicamentos que tu niño está tomando: Por favor se da cuenta de que el coordinador del programa está certificada en el CPR & primeros auxilios. Sin embargo, no hay una enfermera en la escuela durante las horas del campamento de verano.
9 Llamaremos 911 en cualquiera emergencia médica Médico del niño: Teléfono :( ) Dentista del niño: Teléfono:( ) Enfermedad: Exigemos que guarden sus niños en casa si estén enfermos, ambos para su salud y tambien para el bienestar de los otros estudiantes. Si un niño sienta mal durante las horas del campamento para una duración de 20 minutos o más, o si la enfermedad incluya un fiebre de o más alta, vomito o diarrhea, el coordinador del programa llamará al padre/guardián para que levante su niño inmediamente. Si el niño está expuesto a una enfermedad o si la tiene, debes notificar los empleados del programa inmediamente. Accidente: Si sucede un accidente durante las horas del programa, el coordinador llamará al padre/guardián inmediamente. El empleado que cuida del niño completará un reporte de algún accidente considerada serio, proveendo detalles del procedimiento médico que siguió. Pedimos que el padre/guardián lea y firme este documento. Si tratamiento de emergencia sea necesario, el coordinador llamará el padre/guardián inmediamete y el niño será tranportado por ambulancia a la facilidad médica más cercana. Medicamento: Medicamentos serán administrado a su niño por el coordinador del programa. Es necesario que cualquier medicamento para tu nino: Sea traído por padre/guardián directamente al coordinador del programa Esté en el recipiente original, etiquetada con el nombre del niño, fecha, direcciones, y el nombre del médico.. Esté acompañado por instrucciones escritas claramente y el tiempo en que debe tomar el medicamento. El coordinador del programa hará cada intento de dar la medicina a tiempo. Es útil cuando un niño notifica al coordinador cuando llega el tiempo para tomar la medicina. Si la medicina debe volver a casa con el niño al fin del día o de la semana, es la responsabilidad del padre que la recoge del coordinador. Firma del padre/guardián Fecha
10 Solicitud de identificación estudiantil Nuestra agencia usará el número de identificación de su estudiante para poder evaluar la eficacia de nuestros programas e/o intervenciones. Nosotros también le proveeremos estos números de identificación a nuestro patrocinador, United Way, para que ellos puedan combinar los resultados de nuestros programas con los resultados de otros programas que ellos patrocinan a fin de poder evaluar todas sus iniciativas. Las agencias van a someter los números de ID. de los estudiantes para generar un reporte de resultados agrupados en el sistema de [Aggregate Report] sobre la asistencia, disciplina y los logros académicos de todo el grupo. Nosotros no divulgaremos información individual acerca del estudiante. Descarga de media Media Release Entiendo que la exposición pública de las obras de mi niño es un componente crítico del programa, incluyendo pero no limitado a: exposición de las obras del arte, representación teatral viva o grabada, grabaciones de sonido, etc. Además, es possible que los empleoados del programa saquen fotos de los estudiantes para promover el programa y para otros propósitos promocionales. Doy permiso para que fotos/videos de mi hijo/a sean sacados para usos promocionales de United Way for Greater Austin: Si No Nombre del estudiante: Nombre de padre/guardian: Firma de padre/tutor: Fecha:
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