12111 NE First Street, Bellevue, Washington 98005 / P.O. Box 90010, Bellevue

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12111 NE First Street, Bellevue, Washington 98005 / P.O. Box 90010, Bellevue, Washington98009-9010

November 15, 2015

Dear Parents/Guardians,

Thank you for allowing your student to attend the BOOM Experience. OnTuesday, December 15, 2015 the Bellevue School District will be hostinga leadership experiencecalled BreakingOutOf the Margins (BOOM). This will be an experiencefor African American, Latino and Native American male students. This leadership opportunity is open to our middle and high school studentsin grades 7-12 across our district. The BOOM Experience will be an all-day event held at Bellevue College.The Bellevue School District in partnership with Bellevue Collegeis excited for this opportunity and anticipate this will be an enriching experience for your child. This is a free event that is designed to empower and encourage our young men to excel in education and beyond.

The event will take place at Bellevue College, 3000 Landerholm Circle SE, Bellevue, WA 98007.Students will be under the supervision of chaperones at all times. Registration is free, breakfast, lunch and transportation will be provided.

The event begins at 9:30am so we will be picking up your student between 8:30am-9:30am at their schools. The event will endat 1:30 for middle school students and 4pm for high school students. Middle school students will be dropped off at their schools between 1:45-2pm and high school students will be dropped off at their schools between 4-4:15pm.

Please review the enclosed expectations sheet with your student to re-emphasize that students are expected to be courteous and respectful at all times. Parents and school officials will be contacted if a student fails to cooperate with the chaperones. Students who do not follow expectations will be excluded from future field trips and special school events. Registration is a 2 part process. Please register as soon as possible by going to and clicking on BOOM Registration to pre-register. Parents and students should then complete the field trip forms which are attached to this letter and return to the student’s school counselorby Friday, December 4, 2015.

We are very excited for each and every student attending this conference. Our hope is that each student will be inspired and moved to succeed in college, career, and life.

More information can be found on our website: If you have any questions before the trip, please feel free to contact Ramika Toms at (425)456-4027.

Sincerely,

Krischanna Roberson & the BOOM Experience Planning Team

(Required reading with your student)

BOOM Experience Agenda

Tuesday Dec 15, 2015

Bellevue College

Time / Who / What
8:30-9:30 am / All Students / Bus Pick up
9:30-10:00 / All Students / Student arrival to BC Food
10:00-10:30 / All Students / Welcome & Keynote
10:30-10:40 / Conference Transition
10:45-11:30 / All Students / Break out Session 1
11:30-11:45 / Conference Transition
11:45-12:30 / All Students / Break out Session 2
12:30-1:00 / All Students / Lunch & Activity
1:00-1:15 / Middle / Survey
1:15-1:30 / Middle / Depart & Load Buses
1:00-1:10 / Conference Transition
1:15-2:15 / High / Break out Session 3
2:15-2:30 / Conference Transition
2:30-3:30 / High / Small group caucus
3:30-4:00 / High / survey & closing
4:00 / High / Depart & Load Buses

Expectations for Students attending the 1stAnnual BOOM Experience
December 15, 2015

This is a school sponsored trip. You represent your school and the Bellevue School District.
Be respectful of others.
All school policies and rules must be followed. Smoking, drugs or alcohol (use, possession, or being in the same place), and weapons are prohibited
You must stay with your group.
Always let the chaperones know where you are.
Follow the directions of the chaperones.
Use appropriate language at all times.
Listen when others are speaking.
Behave appropriately on Bellevue School District buses.
Maintain good conduct and appearance.
Attend all workshops, sessions, orientations, meetings & ceremonies during the conference.
Have a good time, learn and make good connections with other students and mentors

Student Name: ______

Student Signature: ______

Parent Signature: ______
Parental Authorization and Acknowledgement of Risks

Name of Student:
Student ID #:
School & Grade Level:
Date(s) of trip: December 15, 2015 / Destination: Bellevue College: Bellevue, WA
Purpose: Attend & Participate in the Inaugural BOOM Experience

Supervision:

Krischanna Robersonis the District employee responsible for the trip and may be accompanied by other District staff and approved volunteer chaperones. They have my permission to do so.

An itinerary for the trip is enclosed for your information.

Transportation:

Transportation will be onBellevue school district buses. BSD staff will be driving these vehicles.

Emergency:

If an emergency situation involving illness and/or injury should arise, the Bellevue district staff member in charge has my permission to seek the aid of medical professionals for emergency care.

In the event it becomes necessary for the Bellevue district staff in charge to obtain emergency care for your student, neither s/he nor the Bellevue School District assumes financial liability for expenses incurred because of accident, injury, illness, and/or unforeseen circumstances.

I understand that participation in this field trip is voluntary, that it is not required, and that is exposes my child to some risk(s). I have read and understand the description of the field trip (attached) and authorize my child to participate in the planned components of the field trip. I also understand that participation in the field trip will involve activities off school property; therefore, neither the Bellevue School District, or its employees and volunteers, will have any responsibility for the condition or use of any non-school property.

In the event that unforeseen circumstances arise creating a need for you to contact your student or for information to be relayed to you about an emergency, change in itinerary, etc., an information network has been established. Your contact person is:

Ramika Toms(425)456-4027

(Name of person)(Telephone Number)

Student’s date of birth:
Complete Address:
Parent Contact phone:
Student Contact phone (If applicable):

I give permission for (name of student) to participate in all aspects of this field trip.

My student’s picture can be taken at this event and used for the purposes of promoting positive student activities within the Bellevue School District: ______yes ______no

Signature of Parent or Guardian)Date
Field Trip Emergency Health Form

Name of student: ______Birthdate ______

Name of parent/guardian: ______

Home address: ______

Phone: (home): ______cell (mother) ______

Cell (father) ______work (mother) ______

Work (father) ______

Email address: ______

Student’s physician: ______phone: ______

Name, address, and phone number of two people who could be contacted in case of emergency if the parent/guardian cannot be reached (relatives, close friends). These people may provide information regarding where the parent/guardian might be reached, or they might be asked to give advice/permission for medical care. Please notify these individuals that their names have been given for this purpose.

1) Name / 2)Name:
Address / Address:
Phone: / Phone:
Cell: / Cell:

Permission for Emergency Medical Treatment

In the event that I/we cannot be contacted to authorize emergency medical treatment for ______during his/her participation in the camp/field trip, the Bellevue School District staff member in charge of medical care has my permission to authorize emergency medical treatment. I also give permission for school staff to transport my child to a medical treatment center if needed.

Signature of parent/guardian ______Date: ______

Needed in case of emergency:

Name of insurance company: ______

Name of subscriber: ______

Policy # ______

Health Information: The following health conditions can be of concern; please check any that have a problem in the past or are currently a concern. If your student has a life threatening condition (severe asthma, severe allergic reaction, diabetes, seizures, etc.) a Health Care Plan must be attached.

Condition / Past Problem / Current Problem / Please explain
Abnormal Bleeding
Allergies
Please circle type of allergy: food, insects, medication, environmental, other **
Diabetes **
Frequent infections
Heart/circulatory problems
Seizures **
Intestinal problems (including frequent stomach aches, constipation, diarrhea, indigestion, etc.)
Respiratory problems (including asthma, bronchitis) **
Urinary problems (including bed wetting)
Other, please indicate

**Attached Emergency Health Care Plan

Is your child physically able to take part in all trip activities? Yes ______No ______

If no, what limitations are needed? ______

______

Date of last tetanus immunization ______

If medication(s) is to be taken during the trip, written instructions from the prescribing physician and parental permission must be obtained for each medication. A medication authorization form is attached and must be completed by a physician and returned/faxed to the school nurse. If more than one medication is to be taken, additional copies can be obtained at school. All medications will be kept and dispensed (as ordered by the physician) by a designated school employee. Prescription and non-prescription medication must be sent in the original pharmacy container. Non-prescription (over-the-counter medication) must be clearly labeled with the child’s name, dosage, and time to be given. NO MEDICATION (prescription or non-prescription) CAN BE GIVEN WITHOUT A PHYSICIAN’S ORDER. To accommodate medication needs, all physician medication orders and medication(s) must be to the school nurse byDecember 4, 2015.