Speech and Debate Team

Pinecrest High School, Southern Pines, 9/24/11

[This form must be returned before student may participate in tournament.]

SPEECH AND DEBATE TEAM Ardrey Kell High School

Participation Permission Form 10220 Ardrey Kell Road

Charlotte, North Carolina 28277

Student Name:______

I give permission to the above named son/daughter/ward to participate with the Ardrey Kell High School Speech and Debate Team in a tournament at Pinecrest High School, Southern Pines, NC on 9/24/11, and to travel from AKHS or other CMS location (if necessary, i.e. Myers Park High School) to and from Southern Pines, NC in appropriate transportation provided for this purpose.

In the event of illness or injury in the course of this activity, ANDI can not be reached in a timely manner, I request that measures be taken without delay as the judgment of medical personnel dictates. I hereby give permission to the physicians selected by the adult(s) in charge of this activity to hospitalize, secure anesthesia, and order necessary injections or surgery and otherwise give required medical care of my dependent.

I have filled out the Ardrey Kell High School Speech and Debate Team Insurance and Medical Information form provided as a precondition of my son/daughter/ward’s participation in this activity.

I also understand that the following # is the phone of the tournament -910-603-0690 Libby Carter, but that my son/daughter WILL be provided with a cell phone at the tournament for emergencies. I also understand my son/daughter will NOT be supervised at all times as Ms. Koller or designated CMS staff chaperone has judging responsibilities. She will check in periodically with the students, but is primarily housed in the judge’s lounge, not with the students all day. I take full responsibility for my child during these times.

In the event of illness or injury in the course of this activity, ANDI can not be reached in a timely manner, I request that measures be taken without delay as the judgment of medical personnel dictates. I hereby give permission to the physicians selected by the adult(s) in charge of this activity to hospitalize, secure anesthesia, and order necessary injections or surgery and otherwise give required medical care of my dependent and accept liability for any expenses incurred as a result of medical treatment.

I agree to pay for transportation home for my child/guardian if he/she violates disciplinary rules. I agree to allow random searches of my child’s luggage and personal belongings as deemed necessary.

CMS will cancel all events in a Sever (“Code Red”) and reserves the right to cancel field trips with little or no notice in the event of a High “Code Yellow” Homeland Security Advisory System National Threat Level. If this happens, the district has no obligation to refund fees or deposits paid. By signing, I agree to waive claims against CMS in the event that CMS cancels a field trip for these reasons.

Name of Parent(s)/Guardian(s)______

[please print]

Signature of Parent(s)/Guardian(s)______

[signature]

Date ______Telephone # during date(s) of activity ______

Alternate Contact ______Telephone # ______

[please print]

Code of Conduct

As a member of the Ardrey Kell High School Speech and Debate Team and representative of Ardrey Kell High School, I agree to abide by the rules of conduct set forth by the Charlotte-Mecklenburg Schools, Ardrey Kell High School, and as outlined in the AKHS Speech and Debate Team Handbook. I will respect and abide by the decisions made by those responsible for this trip/tournament. I will NOT use or transport cigarettes, alcohol, drugs, or any other illegal substance, nor use such during the duration of this trip/tournament.

______

[student’s signature]