May 17,2010 Dear EHS Marching Eagle Regiment Families: Once

May 17,2010
Dear EHS Marching Eagle Regiment Families:
Once again it's that time of year when students and parents embark on an exciting
marching season! A tremendous amount of activity will take place before the first
football game and tournament. The first marching band rehearsal is scheduled at the high
school on Saturday, May 22nd from 9:00 am to 1:00 pm. We will start this morning out
with our mandatory Parent Meeting (location pending-either the gym or MPR) so that
you can receive updated information on our upcoming season. The Parent Meeting will
last approximately 1 hour. The students will remain at the school for practice until 1:00
pm.
Highlights of the Mandatory Parent Meeting include:
•
•
•
Discuss schedule events for the marching band season, including Parent
Preview, Band Camp, London, tournaments and fundraisers
Review of final 2009-2010 financials and the budget for our next fiscal
year
The election of the 2010-2011 Executive Board
Please be prepared to finalize the following items during the parent meeting:
•
•
•
Receipt of all permission slips (attached)
Payment of first Jab fee ($130)
o Remaining payments of $130 each are du.e on July] 6, August 1,
September I and October I
Completion and payment of clothing order (see attached forms)
The EHS Marching Eagle Regiment is successful due to the countless hours of
practice & dedication from our talented students, outstanding leadership and teaching
from our director and staff and strong support from parents and our booster organization.
There are many opportunities for parents 'to take part in to support the band.
Chaperoning, building props, hauling equipment, calling parents and assisting with
fundraisers are a few of the key activities that need parental involvement. The Executive
Board is looking forward to collaborating with each of you for a fun and successful band
season for you and your student!
The Etiwanda High School Instrumental Music Booster Board
P.O. Box 327, Etiwanda, CA 91739
MER Color Guard Member
Clothing Order Package
Please use this form to order any new or replacement clothing. We are replacing our
previous color guard warm up suit which is required for all new members. Returning
guard members are welcome to order the new warmup suit, but are not required to. All
MER members must be in MER attire before entering the bus on any football game or
competition trip.
Please make checks out to Etiwanda HS Band Boosters.
Student Name:
First:
Last:
Home Phone:
_
_
Parent Cell:
_
New
Member
Returning
Member
Shoes:
Required
Optional
$30.00
Beanie:
Opti
Optional
$7.00
Not Applicable
Duffle Bag:
Optional
Optional
$30.00
Not Applicable
Sweatshirt:
Optional
Optional
$30.00
Required for XXL size
$2.50
Item
Circle Size
Qty
Amount
Unitard:
L
Total Cost:
......................
_
........................•.••..•
. Method of Payment:
•
Clothing Items will be delivered during band camp.
•
**Returning members may need to purchase a new unitard or shoes. This will be
determined after the costume is finalized.
•
Parent "fan" apparel and tour shirts will be ordered during Parent Preview.
_
---'
Chafley Joint Union High School District
MEDICAL EMERGENCY INFORMATION CARD
Name-~~-,s-'-------------~F~irs7t-----------~M!-"d7i.-.-----Home Address
Grado
Sex
_
Horne Phone (
)
MEDICAL ALERT
CIty
Parent(s) Cell Phone #
Social Security #
Mother
_
Father
ParenVGuardian Name
CONDITIONSREOUIRING
SPECIALMEDICALCARE:
HEALTH PROBLEMS:
_
IN C ASE OF SUDDEN ILLNESS OR ACCIDENT TO THIS STUDENT
1. Contact mother/guardian
2. Contact latller/guardian
at
_=-----,
(Place
0f
emp~Dyme~1I
IPIi.lce
Q1
emplo,f':'Ier!1I
at
0
3. Language Spoken at Home:
Contact 1.
0
English
0
Spanish
Phone (
)
ext.
Phone (
)
ext.
MEDICATION TAKEN REGULARLY:
Other
-:::---:
0I
(Name
ALLERGIES:
Phone (
)
Phone (
)
N<:ighl>Or cr Local RelahvaJ
MEDICATION TAKEN AT SCHOOL:
Contact 2. --------,;iN7,,-m~"
0
Family Doctor
Nc,ghb()f or Local A£:It'ltive)
t
_
Phone (
)
HISTORY OF SEIZURES:
(Name)
0
Health Plan:
I give my permission
Kaiser
0 Blue
Cross
tor school authorities
o Medi-Cal o
Plan/Medi-Cal #
Other
to hili Medi~Cal andior my medical insurance
lor medica! services renoerec at the school site,
DYes
o
No
SCHOOLACCIDENTINS:
whatever
should arise which requires
steps needed
to protect the health
immediate
of this
medical aueruion and we as parents or guardIans
cannot be contacted, you are authorized
SCHOOL
H-12
o
_
USE ONLY
STUDENTTRANSPORTATION:
WALK
Signature
Q
YES
to lake
student.
school personnel on a need 10 know basis
inrorrnarionregardIng a student's cnronic nea Ith condition which may aHect himlher at school Q1M~ shared ~'\Ii1h
DATE
CJ
NO
NO 0
THE DtSTRICT DOES NOT PROVIDE MEDICAL INSURANCE COVERAGE FOR SCHOOL ACCtDENTS.
II an emergency
YES
0
BUS
0
CAR
0
MEO. EXEMP. STATEMENT: ---
of Parent or Guardian
(Rev. 4104)
FIRST AID LOG
COMPLAINT
DATE
TIME: IN
II---.--------------+---c..---.----.--------------IACCIDENT
COMMENTS
CODE
STUDENT COMPLAINT
1. Abrasion/Bruise
2. Sore Throat/Couqh
3 Earache
4. Eye/Foreign Object
5. Toothache
6. headache
7. Stom,.ch Ache
8. Nosetlleed
TEMP.
TIMEOUT
COMMENTS
17.
ts.
19.
20.
21
22
23.
Dizzy
Cramps
Cold {Flu
Laceration
Malaise
P.E. Note
Other
Cleansed and Dressed
Ice Applied
COld Compress
Pressure to Nostrils
Splinter Removed
Eye Washed
r. Eye Patched
1.
2.
3.
4.
5.
6.
FIRST AID
REPORT
BY
INITIAL
IDENTIFICATION
ACTION CODE
CODE
9. Eye Problem
10. Splinter
11. Injury at Home
12. Iniury at School
13. Bee/Insect Sting
14. C"II Slip
15. Brcatiling Problem
t6. Allergy
ACTION TAKEN
CODE
8. Ace Bandage
9. Medicine
10. Splint
11. Advise MD.
12. Other
13. Home
14. Return 10Class
AUTHORIZATION
Student's Name (Last)
TO CONSENT
TO TREATMENT
OF MINOR
(First)
(Birrhdate)
(Middle)
-'(:;L:!]~11~CJ.lH=--l~f4l:..l.~Lru~-'-~1I-1L-l?~L~~L!~.;-:=r-:-:-:--=-::--::--:-,=---~~~A&~~~UO~~~~~~~~~~~
for tho purpose of raking an educational field [tip
,20 _
&om
In such ccneeerion. we ~uthoriu: scch caring adult(s) coconsent to any X-rayexamination,anesthetic, medical or $urgicaldiagnosisor rrcarmenr,and hospital cite be rendered to such minor under (he general
or special supervision, and on the advice of. 2 physician and/or surgeon licensed under the provisions of (he' Medicine PracticeAct. or. ifin another country or SU{(, under the provisions of law in that country or stare, governing
the practiceof medicine;or to consent (0 any XPr.l.y examin••rion, aacstheric. dental or surgicaldiagnosisor treatment, and hospital on: ro be rendered to such minor by a denrisr licensed under me provisionsof the Dental Practice
~
or , if in another state or COUntry, under the: provisions of the law in thlt stare or country governing the practice of medicine.
(0
Whether on an~' occasionsuch CO(l$Cm is rendered to any such medical or dental anemion. it is to be considered within the above previsionsand Iimlcarions.under
the COUrKof the same kind of responsibledeliberations as we as such miner's puents andlor gu~rd~an(s)would have to consider if. We furthc:rauthorize such cuing
the same kinds of circumstances,within rhe full discretion.and in
adult to an<loge for ~nd hire an ambulanceor other eme~cy
vehicle to transport, at our expense.such minor (0 a suitable placewhere medicalor dental care is provided.
Dal~
_
Signature of Parent or GU4lrdi211
Witness
Signanue of Parent or Guardian
Address of Parent or Guardian
••••••••••.•.••
.".....
•••••••••.••.••.•.•.•••.•..••••••
*••••••••.••••.•••••
""•• ""••••••••••••••••
.",.••.•." •.•••••.•. *••••••••.••••••.••••
Emergency Telephone Number
**** ••••• * ••••.•..•**••••••.• *.••1l*•••.•••
*** ••
**.••..•••••.•••.••
Please answer rhe foUowing statements (circle yes or no)
My child:
1. (Yes No) Has a history of seizures or fuinting. Explain,
_
2. (Yes No) Is a diabetic and rakes insulin.
3. (Yes No) Is subject ro specific allergies. If Yes, please specify [he type of a.lI~rgyand medicine prescribed:
_
4. (Yes No) Has a medical condition which may affect participation in any activity, IfY es, please explain:
HEALTH AND ACCIDENT
INSURANCE
.
_
CARRIER;
Carrier
Policy No.
NOTICE
Group No.
CONCERNING
FIELD TRIPS
Chaffey Joinr Union High School District
W.ivC[ of Claims
California Educ-non
Code Section 35330 states rhat the governing board m.~·:
"Conduct fidd trips or excursions in connection with courses of instruccion or school-relared social, educational. cultural. athletic. or ·school band activities to and from
places. in the stare, any other stare, the: District of Columbia. or a foreign country for pupils enrolled in elementary or secondary schools."
This code section further stares rhat:
Use
••All persons making the field trip or excursion shall be deemed. [0 have waived all claims ~insr the district or rhe Stare ofCaliforni.
for injury, accident. illness or dearh
occurring during or by reason of the field rrip or excursion. All adults raking cue-of-stare field trips or excursions and all par<nrs or guardians of pupils r~king our-of-Stare
.
field trips or excursions shall sign a statement waiving such claims."
.
of Priv,te Vehicles for field Trips
Re;spornjbjlily'
Owners. drivers and. passengers furnishing, driving or riding in private vehicles should be aware that under the -law the registered owner and/or the owner's insurance
company.;ire responsible for accidents resulting from the use of such vehicle.
Reimbursemeot for COStS;
Owners furnishing private vehicles for field (rips should not ~ccept reimbursement from.pass~ngers in excess of the COSt of operation of such vehicle. Acceptance of
reimbursement in excess of COStScould bring the opera [ion of ,aid vehicles under laws. rules and regulations controlling vehicles "for hire."
Number of Pmsn",rs;
.
The number of pas~nge~. inciudir.:g the driver, riding in :1private vehicle while on a field trip should never exceed the rated capacity of the vehicle and should not in :any
cue exceed eighr (8). The rransporting of more than eighr could _bring the operation of the vehicle under laws, rules and regulations controlling "school busses:
CONSENJ'
We.
and
Nerice ConCerning:~d
IN FIELD TRIP
-:
,. hereby cerrify that we have read and fully understand rhe above
Trips. a
excursions froml--"E:;'=-_'''W=::·=~~.!.!..='_
Ir is understood that transportation
Date
_
*
for these trips will be provided by 6;,.r..1~U4::u...J'-t_.1JiQ:!..C!2:~.s;:L_~_I_u..L--1..::Jll.~ILu,J.:.-.-'~~!::.:iI<::~~~'-----40':--
* Insert above:
_
Signature of Parent or Guardian
School vehicle
Commercial
School bus
Private vehicle and owner
Other, or
Commercial bus
Tr.Un
S, 5 (!105)
TO PARTICIPATE
Any exceptions
Combination
10
specific trips or forms of-uansponation
Signacun: of Parenr Or Guardian
aircraft
Address
of above
should be noted on the back of this card.
Emergen~'
telephone number
~~
H~ 5dcd, H~
Non-Prescription
&fit R~
Student Medication Authorization
Student Name (printed clearly):
Form
_
(First name, Last name)
Dear Parent:
Help us in providing timely aid to your student in your absence. Please mark the following types of
Over-The-Counter medications that we may safely give to your student:
Only mark those that he or she CAN have in your absence!
o
o
o
o
o
Acetaminophen (generic for Tylenol, Midol PM, Excedrin PM, Anacin PM Aspirin Free, etc)
Antacid (Examples: Tums, Rolaids, etc)
Antibiotic creams (Examples: Neosporin, Triple Antibiotic, etc)
Aspirin or aspirin compounds (Examples: Bayer, Excedrin, etc)
Cough suppressants (Examples: cough drops, throat spray, etc)
o
Diarrhea control (Examples: Imodium AD, Pepto-Bismol, etc)
o
Emmitrol (helps control vomiting)
o
Ibuprofen (Examples: Ibuprofen, Advil, Midol, Nuprin, Motrin, etc)
o
Lip care (Examples: Blistex, Chapstick, etc)
o
o
o
o
Motion sickness (Examples: Dramamine, etc)
Naproxen Sodium (generic for Aleve)
Skin care (Examples: Hydrocortisone cream.jiand cream, etc)
Upset stomach (Examples: Pepto-Bismol, M~k of Magnesia, etc)
I hereby authorize the adult supervisors of the Etiwanda High School Marching Eagle Regiment to
provide the afore-mentioned student with medication from any of the marked categories indicated
above. I also reserve the right to modify or nullify this list, in writing, to the appropriate authorities, at
any time.
Printed Parents name:
Relationship:
------------------------_
Signature:
School Year: ---------
Authorized by Director Jeremy Hackworth Signature:
Date:
_
--------------_
Student & Parent Information
PLEASE PRINT
Students Full Name:
-------------------------------------------
Billing Address:
City:
_
State: CA
--------------------------
Instrument
Graduating Year:
-------------------------
Fathers Name:
Zip: -------
-----------
--------------------------------------------
Home Phone: (
Mothers Name:
Home Phone: (
)
Cell Phone: (
)
_
--------------------------------------------)
Cell Phone: <__
)
_
E,MAIL FOR BILLING PURPOSES
Fathers:
--------------------------
Mothers:
@
@
-----------------------------------