Kinsella Magnet School of Performing Arts

KINSELLA MAGNET SCHOOL OF PERFORMING ARTS

8TH GRADE WASHINGTON, D.C. FIELD TRIP

INFORMATION PACKET and PERMISSION SLIP

______(print student’s full name) has my permission to travel with a group of eighth grade students of the Kinsella Magnet School of Performing Arts (KMSPA) on an overnight field trip to Washington, D.C., from Monday, April 20th to Thursday, April 23rd, 2015. Departure will be at 6:30 a.m. on Monday, April20thfrom the school parking lot. Students should be present by 6:00 a.m. The students will return at approximately 8:30 PM on Thursday, April 23rdand are reminded to make arrangements for transportation home at 8:30 PM on Thursday prior to leaving on the trip.

The entire tour is being arranged through Post Road Tours. The cost of the trip is $270.00 per student, payable by March 18th 2015. All the materials contained in this packet must be completed as outlined in this packet. Any student who wishes to participate in this trip must submit the following according to these directions:

1. Completed “Field Trip Permission” Packet to Ms. Tocionis by the end of our parent meeting night (beginning at 6:00 PM on Wednesday, March 18th, 2015).

1. The “Medication Permission Form” (attached), needs to be given to Ms. Tocionis by the end of our parent meeting night(beginning at 6:00 PM on Wednesday, March 18th, 2015).

1. Any necessary medications need to be appropriately labeled and accompanied by a “Medication Permission Form” (see above). The medication must be turned in to Ms. Tocionis the morning we leave from school (Monday, April20th).

1. $270.00 needs to be turned in to Ms. Tocionis by the end of our parent meeting night (beginning at 6:00 PM on Wednesday, March 18th); obtain a receipt (from Ms. Tocionis) for the payment, which may be in cash, check, or money order. Checks should be made out to Kinsella Magnet School of Performing Arts.

1. A copy of the student’s medical insurance card must be turned in to Ms. Tocionis by the end of our parent meeting night (beginning at 6:00 PM on Wednesday, March 18th, 2015).

1. Students who have not submitted the 5 items described above by the deadline will not be allowed to participate in the trip.

1. Parents / Guardians should note that participants may be provided with pocket money to pay for all souvenir purchases, as well as to pay for any snacks. The amount is to be determined by the parent and or guardian.

Guidelines for Student Behavior on the Trip:

1. Each student must conduct her/himself in a mature, well-behaved manner and must obey all directions from the chaperones.

2. The KMSPA Conduct Code and Dress Code as outlined in the Student Handbook are in effect for the entire trip. Students need to be dressed in an appropriate school uniform at all times, unless specified by Ms. Tocionis during the trip. Students will be allowed to wear appropriate length shorts and/or capri’s on especially warm days. Again, Ms. Tocionis will notify students when the weather permits wearing any clothing not considered appropriate school uniform.

3. The students must remain with their assigned chaperone while visiting historical sites /museums. Any student leaving a chaperone will be subject to disciplinary action upon return to the Middle School and also might be barred from field trips and schoolactivities, including promotion activities, for the remainder of this school year.

4. The school administration advises parents / guardians and students that all student possessions and luggage are subject to search.

5. Students must make telephone calls from a cellular phone (no hotel room phone use).

6. Chaperones will check all rooms before curfew. Areas such as closets,bathrooms, etc. must be inspected before lights out. Students must not leave their roomsafter lights out.

Academic Expectations:

1. Students will have an academic note-taking packet to complete during the trip.
2. Students must complete all assignments in the academic packet prior to returning to school.
3. These assignments will be turned in to all content area teachers for grades.
4. If a student loses the academic packet, this will result in multiple zeros from content area teachers.
5. Students will also have a scrapbook assignment to complete upon their return from Washington, D.C. This assignment is due on a date to be determined by Ms. Tocionis and Mrs. Piotrowski. The scrapbook assignment will serve as a culmination project reflecting the student’s experiences in Washington, D.C.
6. Students are advised to maintain possession of any items they obtain from the many experiences in Washington, D.C. to use in their scrapbook assignment when they return to Connecticut.

Washington, D.C. Trip Parental Agreement

______I understand these guidelines, I have made certain that my child understands them,and I require my child to comply with them.

______I understand that my child is eligible to participate in the Washington, D.C. trip, buts/he will not attend.

______

Student’s Name

______

Parent / Guardian Signature Date

Parent’s Request to Administer Medication on Trip: “Medication Permission Form”

Connecticut state law requires a written statement from the physician to allow a student totake any medication. Please have your doctor include the information given belowconcerning the medication prescribed. Have your child bring this completed packet by Wednesday, March 18t5.

The medication should be carried to school in the original container, appropriately labeled bythe pharmacy or physician.

This law also applies to administration of over the counter drugs, such as aspirin, Acetaminophen (Tylenol),Ibuprofen (Motrin) and all allergy medication. These drugs cannot be dispensed on the trip unless we are sodirected by your physician.

Student’s name ______Age ______

Street Address ______

Diagnosis ______

Medication Dosage Time of Administration

1. ______

2. ______

3. ______

Possible Side Effects

______

______

Parent’s / Guardian’s Signature Date

______

Family Physician’s Signature Date

THIS FORM WILL NOT BE ACCEPTED FOR DRUG ADMINISTRATION UNLESS

ALL BLANKS ARE COMPLETED

EMERGENCYMEDICAL INFORMATION

To Whom It May Concern:

By reason of my son / daughter being on a field trip to Washington, D.C., I, as a parent and /or legal guardian of

______(student’s full name – please print)

Hereby authorize any emergency medical treatment by a physician or surgeon attached to the staff of an accredited hospital, if such treatment is deemed necessary. I will assumenecessary expense, if any.

______

Parent’s / Guardian’s Signature Date

Health Insurance Company ______

Policy Number ______

Please attach a copy of the medical card if possible.

MEDICAL EMERGENCY INFORMATION

Student’s Date Of Birth ______

Parent / Guardian Name ______

Address ______

Home Phone ______

Work Phone Number (Mother) ______(Father) ______

Cell Phone Number (Mother) ______(Father) ______

If parents are unavailable in an emergency, please notify:

Name ______

Address ______

Phone ______

STUDENT HEALTH INFORMATION

Student’s Full Name ______

Please indicate if your child has any disabilities. If so, on the attached form, please outline any medical procedures that might have to be followed.

Epilepsy ______

Hay Fever ______

Asthma ______

Bee Sting Allergy ______

Diabetes ______

Heart Problems ______

Ulcers ______

Kidney Problem ______

Bladder Problems ______

Fainting ______

Motion Sickness ______

Sleep Walking ______

Food Allergies (list the foods) ______

Drug Allergies (list the drugs)______

Allergies (list substances) ______

Other ______

Blood Type (if known) ______

Date of last tetanus booster (if known) ______

Is your child on daily medication at home? ______

If yes, list the medication(s) and dosage ______

Is your child in general good health and able to participate in the field trip? ______

Has your child had an operation or serious injury in the last two years? ______

Does your child have any recurring physical or emotional problems? ______

______

Date of your child’s most recent physical examination ______

Child’s Physician ______Phone ______

IMPORTANT:

Medication must be accompanied by a written doctor’s order. Themedication, which needs to be in the proper container, must be given to Ms. Tocionis by April 20th(the morning of the trip). The “Medication Permission Form” is due to Ms. Tocionis by Wednesday, March 18th.

______

Parent’s / Guardian’s Signature Date

KMSPA Washington, D.C. 2015, Page: 1