New Student Information Packet

June1,2016
DearLindenHallFamily,
WelookforwardtoyourarrivaltoLititz,Pennsylvania,andourbeautifulcampusinAugust.We’re
workinghardthissummertoprepareforanotherexcitingandsuccessfulschoolyearwithyour
daughters.
Pleaseusethefollowingchecklisttocompleteyourdaughter’sLindenHallStudentRegistration--a
packetofregistrationformsthatwerequestyousubmitbytheduedatesindicatedbelow.Inthis
registrationpacket,youwillalsofindhelpfulinformationsuchasimportantdates,traveltips,Student
Lifefundamentals,LindenHallMedicalservices,andmore.
Uponreviewingandcompletingthispacket,pleasedonothesitatetocontactourSchoolNurse,Beth
Gibble,atbgibble@lindenhall.orgforquestionsrelatedtoLindenHallMedicalservices.Forallother
non-medicalquestions,pleasecontactLauraMitchell,AssistantDeanofStudents,at
[email protected].
StudentRegistrationChecklist(*Required):
□ImportantDatesforSchoolYear2016-2017
□MedicalFormsandInformation*
□AthleticOfferings&FallRegistrationInfo
□Parent/GuardianCommunicationInformationSheet*
□StudentCellPhoneRegistration
□LindenHallOff-CampusorOvernightTripPermissionandReleaseForm*
□PublicSchoolTransportation(LocalStudents)
□StudentAutomobilePolicy
□DressCodeInformation
□FlynnO’HaraUniformOrderingInformation
□NewBoardingStudentProfile
□WhattoBringChecklist(BoardingStudents)
□BoardingStudentTravelInformation
OurStudentHandbookiscurrentlybeingrevisedandwillbeavailableforyoutoreadlaterthissummer.
TheParentandStudentHandbookAcknowledgementwillbeprovidedtoyouatalaterdatetobesigned
byyouandyourdaughter(s)andsubmittedtoourStudentLifeoffice.Allotherrequiredandapplicable
formsareduenolaterthanJuly15,2016,toAssistantDeanofStudents,LauraMitchellat
[email protected](717)627-1384.Pleasedonothesitatetocontactusanyquestions
youhaveasyourfamilypreparesforthestartofschool.Ourteamishappytohelp!
Iwishyourfamilyafunandsafesummer!
BestRegards,
MichaelE.Waylett
HeadofSchool
IMPORTANTDATESFORSCHOOLYEAR2016-2017
Pleaseseetheschoolcalendarontheschoolwebsiteforeventsandactivities;thiscalendar
providesinformationaboutschoolanddormopeningdays.
Date
Event
Sunday,August14,2016
Dormsopenforfallsportspre-season
Tuesday,August23,2016
DORMSOPENforallboardingstudents
Wednesday,August24,2016
Orientationactivitiesbegin
Thursday,August25,2016
Testingfornewandreturningstudents
Friday,August26,2016
Allstudentsrequiredtobeoncampus
Monday,August29,2016
Firstdayofclasses
Monday,September5,2016
LaborDay–NOSCHOOL
Thursday,September15,2016
BacktoSchoolNightforparents
Thursday,October13,2016
In-servicedayforFaculty–NOSCHOOL
Friday,October14,2016
Octoberbreak–NOSCHOOL
Friday,October28–Sunday,October30,2016 FallParents’Weekend
Friday,November18,2016
FallBreakbeginsafterclass
Saturday,November19–
FallBreak–NOSCHOOL
Saturday,November26,2016
Sunday,November27,2016
Boardingstudentsreturnby8:00p.m.
Monday,December12–
EXAMWEEK–allstudentsmustattend
Friday,December16,2016
Friday,December16,2016
WinterBreakbeginsafterexams
Saturday,December17,2016–
WinterBreak–NOSCHOOL,DORMSCLOSED
Sunday,January1,2017
Monday,January2,2017
Boardingstudentsreturnby8:00p.m.
Tuesday,January3,2017
Classesresumeforallstudents
Thursday,February2,2017
In-servicedayforFaculty–NOSCHOOL
Friday,February3,2017
Februarybreak–NOSCHOOL
Friday,March10,2017
SpringBreakbeginsafterclass
Saturday,March11–
SpringBreak–NOSCHOOL
Saturday,March18,2017
Sunday,March19,2017
Boardingstudentsreturnby8:00p.m.
Friday,March31–Saturday,April1,2017
SpringParents’Weekend
Friday,April14–Monday,April17,2017
EasterBreak–NOSCHOOL
Thursday,May19–Wednesday,May24,2017 FINALEXAMS
Thursday,May25,2017
End-of-yearCeremonies,Baccalaureate
Friday,May26,2017
Graduation–allstudentsattend*
Saturday,May27,2017
DORMSCLOSE
*Therewillbeaseparatecalendarforseniorfamiliesregardinggraduationactivitiesreleased
duringthesummerof2016.
RevisedMarch2016
June 1, 2016
Dear parents/guardians of students,
Welcome to the 2016-2017 school year at Linden Hall! We look forward to working with you and your
family, and to making a positive contribution to your daughter’s health and well-being.
Linden Hall uses Magnus Health SMR (Student Medical Record), a web-based system that provides you
continuous access to your daughter’s health records, and the ability to make updates as needed. Your
daughter will also have the option to take this electronic file with them after graduation.
You will be able to access Magnus Health SMR with a username and password that you will receive via
email from Magnus. We ask that you log in and enter the required health information for your daughter
for the upcoming school year no later than July 1, 2016 (or upon enrollment.)
To access Magnus Health SMR, follow the steps below:



Click on the link, in your email, that you received from Magnus Health SMR.
On the Left you will see a link for Magnus Health, entitled “Link Title”. Clicking this link will direct
you to your “Front Desk” in your student’s SMR.
Complete all the medical requirements for each student by answering online questions and/or
submitting documents to Magnus Health by scanning and uploading directly to the student’s
SMR.
Timely submission of health information is vital in order to prepare for the first day of school. After you
have had an opportunity to explore the Magnus Health SMR website, please feel free to contact me with
any questions you may have. If you have any technical issues or need customer support with this
process, please contact Magnus Health directly at 1-877-461-6831 or [email protected].
Please review the attached form regarding submitting the required medical documents for this
upcoming school year.
Sincerely,
Beth Gibble, LPN
Linden Hall School Nurse
[email protected]
DearParents/Guardians,
Wearelookingforwardtoyourdaughter(s)continuingorbeginningtheirjourneyhereatLindenHall.Themedical
documentslistedbelowmustbesubmittedviayourdaughter’sMagnusHealthaccountonorbeforeJuly1,2016(oras
soonasyouenroll.)
PHYSICALEXAM
Allstudentscurrentlyentering6thand11thgrades,andallnewstudentsarerequiredtohaveaphysicalexamreport
thathasbeencompletednoearlierthanAugust18,2015.Pleaseuploaditintothe“AnnualPhysicalExamForm”section
intheMagnusHealthaccount.
IfastudentarrivesatLindenHallwithoutacompletedandsignedphysicalexamform,theschoolwillmake
arrangementsforanexam.Allassociatedfeeswillbechargedtothestudentaccountorpaidforupfrontbythestudent
orfamily.
DENTAL
ALLstudentsentering7thgrade,newstudents,andthosewithoutapreviouslysubmitteddentalform,mustsubmita
formcompletedbyyourdentist.Pleaseuploaditintothe“ProofofDentalExam”sectionintheMagnusHealthaccount.
Ifthedentalformisnotsubmitted,theschoolwillmakearrangementsforthisexam.Allassociatedfeeswillbecharged
tothestudentaccountorpaidforupfrontbythestudentorfamily.
VACCINATIONS
Acopyofvaccinationrecordisalsoneededforallnewstudentsandanystudentswhodidnotpreviouslysubmitthis
documentation.Toreferencealistoftherequiredvaccinations:
§
§
§
Pleasevisit:http://www.healthychildren.org/
Clickon“ImmunizationSchedules”
Clickon“Easy-to–ReadVersionforParents”(7-18years)
Pleaseuploadacopyofimmunizationrecordintothe“ProofofImmunization”sectionoftheMagnusHealthAccount.
Studentswhodonotsubmitdocumentationofreceivedvaccinations,willhavevaccinationsscheduledbyLindenHall.
Allassociatedfeeswillbechargedtothestudentaccountorpaidforupfrontbythestudentorfamily.
PPD(TuberculinTest)
ALLnewstudentsandstudentsentering9thgradearerequiredtohaveaPPDtest.Anystudentwhoreceivedthetestin
thelast2yearsmayprovidedocumentationfromtheirphysician.
•
•
YourphysicianshoulddocumentPPDtestingonthephysicalform.
IftheresultofthePPDwaspositive,ORifthestudenthasdocumentationofhavinghada“BCG”vaccine,achest
x-rayisrequired.
Ifastudentarrivesatschoolwithoutappropriatedocumentation,LindenHallwillarrangeforaPPDtestorchestx-ray.
Allassociatedfeeswillbechargedtothestudentaccountorpaidforupfrontbythestudentorfamily.
INSURANCE
ALLstudentsarerequiredtohaveproofandacopyoftheirmedicalinsurancecarduponarrivalatLindenHall.
InternationalstudentswhoarrivewithoutproofofinsurancewillberequiredtopurchaseInternationalStudent
Accident/SicknessInsuranceonline.Pleaseclickonthislinkformoreinformation:www.isminc.comandclickonthe
Insurancetab.StudentsMUSThavecoveragefortheentirelengthofstayatLindenHall.Itisrecommendedthat
studentsselecttheGoldplan,asthisplanhasthemostcomprehensivemedicalcoverage.Pleaseuploadacopyofthe
insurancecardtothe“ProofofHealthInsurance”sectionintheMagnusHealthaccount.
•
ThecostofthisinsuranceisNOTincludedinthetuition.
CONSENTTOTREATMENT
ALLstudentsmusthaveasigned“ConsenttoTreatment”formonfile.ThisformallowsLindenHallstafftosecure
treatmentforstudentsincaseofemergencyillness,injury,orothercondition.Intheeventofemergency,thisformis
presentedtothestaffatthefacilitywheretreatmentisbeingsought.Pleasesignthisformanduploaditintothe
“ConsenttoTreatment”sectionintheMagnusHealthaccount.
OVERTHECOUNTERMEDICATIONS
ALLstudentsmusthaveasigned“PermissionforOvertheCounterMedications”formonfile.Thisformallowsthe
SchoolNursetodispenseover-the-countermedicationsforcommonailmentssuchas:headache,menstrualcramps,
allergicreactions,andfever.Pleasesignthisformanduploaditintothe“OvertheCounterMedications”sectioninthe
MagnusHealthaccount.
INFLUENZAVACCINATIONS
StudentshavetheoptiontoreceivethefluvaccinationatLindenHallwhenitbecomesavailableinthefall.Itishighly
recommendedasaprecaution.Aformisincludedforyoutoelecttohavethevaccinationprovidedatasmallfee,which
willbechargedtothestudentaccount.Pleasesignthisform,indicatingwhetherornotyouwouldlikeforyourdaughter
toreceivetheinfluenzavaccineanduploaditintothe“InfluenzaVaccinePermissionForm”sectionintheMagnus
Healthaccount.
SCHOOLPOLICIES
Pleasereviewthestudenthandbookforallotherinformationregardingourschoolhealthcaredepartmentrulesand
regulations.PleasenotethatLindenHalldoesnotallowstudentstokeepmedicationsofanykind(includingbutnot
limitedtomedicines,over-the-countermedicines,herbalsupplements,vitamins,prescriptions,diuretics,etc.)Theonly
exceptionsareinhalersandEpi-Pens.
Foryourconvenience,wehaveincludedacopyofeachoftherequiredforms.Theseformsarealsoavailableonthe
Magnusaccountoronlineatwww.lindenhall.org.
Pleasecompleteandsubmitnecessarymedicalformsbyscanninganduploadingtheminto
yourdaughter’sMagnusHealthaccountorfaxingthemto(888)803-4250Thankyou!
1001382270_25451 2_2
Consent to Treatment
Linden Hall
Parent or guardian to complete
Student Name
Date of Birth
Parent/Guardian Printed Name
I authorize the Health Center clinical staff to administer medications, to hospitalize, and/or secure treatment for my
child in case of medical, surgical, dental, psychological, or other emergency illness, injury or other condition. The
school physician or consultant reserves the right to perform diagnostic laboratory or other tests including radiological
exams, to make referrals (subspecialty, medical, dental, emergency), and to prescribe treatment and medication
according to his/her best judgment and discretion.
I authorize any physician, counselor, health care provider or insurance company to release to, or obtain from, the
Heath Center any past or current information including but not limited to, medical or psychological information,
medication use history, substance use history, or educational information needed for the diagnosis, care, treatment,
education or processing of insurance claims of my child. I authorize the Health Center to act on my child’s behalf in all
matters of medical or psychological care and health insurance.
I give consent to the Health Center and their agents to use and disclose my child’s protected health information as
needed to carry out health care, treatments and payment activities in the ongoing care, diagnosis and education of my
child/ward. I give permission to the Health Center to release to the staff on a need-to-know basis any of this same
information. I agree to allow all Health Center staff discussions as needed, either written, verbal, electronic or faxed
with other medical personnel and health care providers, school staff or insurance companies regarding my child.
I understand that communication from the Health Center will be to the primary custodial parent unless otherwise
requested. I understand that all Health Center charges (which may include fees for some clinical supplies and/or
procedures, transportation fees to medical appointments, etc.) will be charged to my child/ward’s account. If
medications or supplies are ordered from the local pharmacy charges will be submitted to my insurance company or
credit card by the local pharmacy. I understand that I am responsible for all claims and matters related to my insurance
company. I understand I will be responsible for all incurred costs of health care regardless of surrounding
circumstances or my insurance coverage. I understand and acknowledge that any material omission or misstatement
in the medical forms may constitute grounds for termination of the student’s enrollment without regard to the
significance of the undisclosed information. I release school from any liability arising from any situation related to the
existence of a medical or psychological condition that was not disclosed to the School. I agree to notify the Health
Center of any condition, treatment or medication arising while my child is enrolled at the School.
I understand that the medical doctor has final approval regarding health care and medication administration plans,
clearance for and return to activities, and compatibility of medical needs in setting of the school environment. Further
information about policies and procedures pertaining to student health can be found under health services and in the
handbook online at the schools website.
Parent/Guardian Signature
Relationship
Date
Page 1 of 4: STUDENT HISTORY
H511.336 (Rev. 9/2012)
PARENT / GUARDIAN / STUDENT:
Private or School
PHYSICAL EXAMINATION
Complete page one of this form before
student’s exam. Take completed form to
OF SCHOOL AGE STUDENT
Bureau of Community Health Systems
Division of School Health
appointment.
Student’s name __________________________________________________________________________
Today’s date___________________________
Date of birth ________________________
Gender:  Male
Age at time of exam___________
 Female
Medicines and Allergies: Please list all prescription and over-the-counter medicines and supplements (herbal/nutritional) the student is currently taking:
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Does the student have any allergies?  No  Yes (If yes, list specific allergy and reaction.)
 Medicines
 Pollens
 Food
 Stinging Insects
Complete the following section with a check mark in the YES or NO column; circle questions you do not know the answer to.
GENERAL HEALTH: Has the student…
YES
NO
1. Any ongoing medical conditions? If so, please identify:
 Asthma  Anemia  Diabetes  Infection
Other_________________________________________________
Has the student…
31. FEMALES ONLY: Had a menstrual period?
 Yes
If yes: At what age was her first menstrual period? ______
How many periods has she had in the last 12 months? ______
Date of last period: ___________
4. Ever had a seizure?
5. Had a history of being born without or is missing a kidney, an eye, a
testicle (males), spleen, or any other organ?
DENTAL:
YES
Last dental visit:  less than 1 year
YES
NO
8. Had headaches with exercise?
SOCIAL/LEARNING:
 1-2 years  greater than 2 years
Has the student…
9. Ever had a head injury or concussion?
34. Been told he/she has a learning disability, intellectual or
developmental disability, cognitive delay, ADD/ADHD, etc.?
10. Ever had a hit or blow to the head that caused confusion, prolonged
headache, or memory problems?
35. Been bullied or experienced bullying behavior?
YES
NO
40. Had concerns about weight; been trying to gain or lose weight or
received a recommendation to gain or lose weight?
15. Been prescribed glasses or contact lenses?
YES
NO
16. Ever used an inhaler or taken asthma medicine?
41. Used (or currently uses) tobacco, alcohol, or drugs?
FAMILY HEALTH:
42. Is there a family history of the following? If so, check all that apply:
 Anemia/blood disorders
 Inherited disease/syndrome
 Asthma/lung problems
 Kidney problems
 Behavioral health issue
 Seizure disorder
 Diabetes
 Sickle cell trait or disease
 Other________________________________________________
17. Ever had the doctor say he/she has a heart problem? If so, check
all that apply:
 Heart murmur or heart infection
 High blood pressure
 Kawasaki disease
 High cholesterol
 Other:_____________________
18. Been told by the doctor to have a heart test? (For example,
ECG/EKG, echocardiogram)?
19. Had a cough, wheeze, difficulty breathing, shortness of breath or
felt lightheaded DURING or AFTER exercise?
20. Had discomfort, pain, tightness or chest pressure during exercise?
21. Felt his/her heart race or skip beats during exercise?
YES
NO
22. Had a broken or fractured bone, stress fracture, or dislocated joint?
43. Is there a family history of any of the following heart-related
problems? If so, check all that apply:
  Brugada syndrome
 QT syndrome
 Cardiomyopathy
 Marfan syndrome
 High blood pressure
 Ventricular tachycardia
 High cholesterol
 Other________________
44. Has any family member had unexplained fainting, unexplained
seizures, or experienced a near drowning?
23. Had an injury to a muscle, ligament, or tendon?
24. Had an injury that required a brace, cast, crutches, or orthotics?
45. Has any family member / relative died of heart problems before age
50 or had an unexpected / unexplained sudden death before age
50 (includes drowning, unexplained car accidents, sudden infant
death syndrome)?
25. Needed an x-ray, MRI, CT scan, injection, or physical therapy
following an injury?
26. Had joints that become painful, swollen, feel warm, or look red?
28. Ever had herpes or a MRSA skin infection?
NO
39. Shown a general loss of energy, motivation, interest or enthusiasm?
14. Had any problem with his/her eyes (vision) or had a history of an
eye injury?
27. Had any rashes, pressure sores, or other skin problems?
YES
38. Been worried, sad, upset, or angry much of the time?
13. Noticed or been told he/she has a curved spine or scoliosis?
Has the student…
NO
37. Exhibited significant changes in behavior, social relationships,
grades, eating or sleeping habits; withdrawn from family or friends?
12. Ever been unable to move arms or legs after being hit or falling?
SKIN:
YES
36. Experienced major grief, trauma, or other significant life event?
11. Ever had numbness, tingling, or weakness in his/her arms or legs
after being hit or falling?
Has the student...
NO
33. Name of student’s dentist: ________________________________
7. Had frequent muscle cramps when exercising?
BONE/JOINT:
 No
32. Has the student had any pain or problems with his/her gums or teeth?
6. Ever become ill while exercising in the heat?
Has the student...
NO
30. Had a history of urinary tract infections or bedwetting?
3. Ever had surgery?
HEART/LUNGS:
YES
29. Had groin pain or a painful bulge or hernia in the groin area?
2. Ever stayed more than one night in the hospital?
HEAD/NECK/SPINE: Has the student…
GENITOURINARY:
YES
NO
QUESTIONS OR CONCERNS
46. Are there any questions or concerns that the student, parent or
guardian would like to discuss with the health care provider? (If
yes, write them on page 4 of this form.)
I hereby certify that to the best of my knowledge all of the information is true and complete. I give my consent for an exchange of
health information between the school nurse and health care providers.
Signature of parent / guardian / emancipated student_____________________________________________________ Date_______________
Adapted in part from the Pre-participation Physical Evaluation History Form; ©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of
Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
Page 2 of 4: PHYSICAL EXAM
STUDENT NAME:
STUDENT’S HEALTH HISTORY (page 1 of this form) REVIEWED PRIOR TO PERFOMING EXAMINATION: Yes 
No 
11 
Other

Height:
(
) inches
Weight:
(
) pounds
BMI:
(
)
BMI-for-Age Percentile: (
Pulse:
(
*ABNORMAL FINDINGS / RECOMMENDATIONS / REFERRALS
DEFER
6
NORMAL
K/1 
*ABNORMAL
CHECK ONE
Physical exam for grade:
)%
)
/
)
Corrected

Blood Pressure: (
Hair/Scalp
Skin
Eyes/Vision
Ears/Hearing
Nose and Throat
Teeth and Gingiva
Lymph Glands
Heart
Lungs
Abdomen
Genitourinary
Neuromuscular System
Extremities
Spine (Scoliosis)
Other
TUBERCULIN TEST
DATE APPLIED
RESULT/FOLLOW-UP
DATE READ
MEDICAL CONDITIONS OR CHRONIC DISEASES WHICH REQUIRE MEDICATION, RESTRICTION OF ACTIVITY, OR WHICH MAY AFFECT EDUCATION
(Additional space on page 4)
Parent/guardian present during exam: Yes

No 
Physical exam performed at: Personal Health Care Provider’s Office
exam______________20______

School 
Date of
Print name of examiner _______________________________________________________________________________________________________
Print examiner’s office address___________________________________________________________________ Phone_______________________
Signature of examiner______________________________________________________________________ MD DO PAC CRNP 
Page 3 of 4: IMMUNIZATION HISTORY
STUDENT NAME:
HEALTH CARE PROVIDERS: Please photocopy immunization history from student’s record – OR – insert information below.
IMMUNIZATION EXEMPTION(S):
Medical
Date Issued:___________ Reason: __________________________________________________ Date Rescinded:___________
Medical
Date Issued:___________ Reason: __________________________________________________ Date Rescinded:___________
Medical
Date Issued:___________ Reason: __________________________________________________ Date Rescinded:___________
NOTE: The parent/guardian must provide a written request to the school for a religious or philosophical exemption.
VACCINE
DOCUMENT: (1) Type of vaccine; (2) Date (month/day/year) for each immunization
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Diphtheria/Tetanus/Pertussis (child)
Type: DTaP, DTP or DT
Diphtheria/Tetanus/Pertussis
(adolescent/adult)
Type: Tdap or Td
Polio
Type: OPV or IPV
Hepatitis B (HepB)
Measles/Mumps/Rubella (MMR)
Mumps disease diagnosed by physician
Varicella: Vaccine
Date:__________
Disease
Serology: (Identify Antigen/Date/POS or NEG)
i.e. Hep B, Measles, Rubella, Varicella
Meningococcal Conjugate Vaccine (MCV4)
Human Papilloma Virus (HPV)
Type: HPV2 or HPV4
Influenza
Type: TIV (injected)
LAIV (nasal)
Haemophilus Influenzae Type b (Hib)
Pneumococcal Conjugate Vaccine (PCV)
Type: 7 or 13
Hepatitis A (HepA)
Rotavirus
Other Vaccines: (Type and Date)
Page 4 of 4: ADDITIONAL COMMENTS (PARENT / GUARDIAN / STUDENT / HEALTH CARE PROVIDER)
STUDENT NAME:
H514.027 (08/2011-under review)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH
PRIVATE DENTIST REPORT
OF DENTAL EXAMINATION OF A PUPIL OF SCHOOL AGE
NAME OF SCHOOL ___________________________________________ DATE __________________ 20 ___
NAME OF CHILD
AGE
_________________________________________________
Last
First
Middle
SEX
M
GRADE
SECTION/ROOM
F
ADDRESS
______________________________________________________________________________________________
No. and Street
City or Post Office
Borough/Township
County
State
Zip
REPORT OF EXAMINATION
TOOTH CHART
1
2
32
31
UPPER
LOWER
RIGHT
4
5
6
A B C
30 29 28 27
T S R
3
7
D
26
Q
8
E
25
P
9
F
24
O
10
G
23
N
11
H
22
M
LEFT
12 13
I
J
21 20
L
K
14
15
16
19
18
17
Upper
Lower
UPPER
Upper
LOWER
Lower
Is The Child Under Treatment?
Yes
No
Treatment Completed
Yes
No
__________________________________________
Date of Dental Examination
__________________________________________
Signature of Dental Examiner
__________________________________________
Address
__________________________________________
Print Name of Dental Examiner
Influenza Vaccine Permission
Linden Hall
2016-2017 School Year
Influenza is a virus that spreads from infected persons to the nose or throat of others. The influenza vaccine
can help prevent influenza. Each year the vaccine is updated and a new one is given each year to help
prevent influenza.
The flu vaccine is generally well tolerated. Possible reactions to the injection are: redness, tenderness or
hardness at the injection site for a few days. Also, mild fever, muscle aches or headache within the first 2
days. Rarely, an allergic reaction can occur immediately.
Reactions to the inhaled flu mist are: increased risk of wheezing for people with asthma, runny nose, sore
throat or cough.
DO NOT TAKE THE FLU VACCINE IF:
• You have a severe allergy to eggs/chicken or chicken feathers or dander
• You ever had a serious reaction to the flu shot or have an allergy to any ingredient in the vaccine
• You have a fever
CHECK WITH YOUR DOCTOR FIRST IF:
• You have had Guillain-Barre Syndrome
• You are pregnant
• You have an underlying medical condition (Flu Mist)
I have read the information about the influenza virus. I understand the benefits and risks of the vaccine.
 ___________ Yes, I give permission for my daughter to receive the flu vaccine
 ____________ No, I do not wish for my daughter to receive the flu vaccine
_______________________
Student Name (Printed)
________________________
Parent Signature
____________
Date
A limited number of Flu Mist doses are available upon request.
Please indicate by placing your initials here if you wish for your daughter to receive the Flu Mist.________
IF Flu Mist is not available, the injectable form of the vaccine will be given unless you specify by making a
notation in the blank space below that you do not wish for your daughter to receive the injectable form of the
vaccine.
Thank you
PermissionforOvertheCounterMedications
LindenHall
Parentorguardiansignaturerequired
_________________________________________________
PRINTStudentName _________________
Dateofbirth
________________________________________________
PRINTParent/GuardianName
AtLindenHall,whenstudentsaresick,itissometimesdeemedwisetoprovidethemwithover-the-countermedication
forsymptomrelief,therebyenhancingtheircomfortlevel.
TheSchoolNursekeepsonhandanumberofover-the-countermedications.Togetherwiththesupervisingphysician,
shecanprovidemedicallyappropriatedosesofmedicationsforcommonailmentsincluding,butnotlimitedto:
•
•
•
•
•
•
•
•
•
•
•
Headaches
Menstrualcramps
Gastrointestinaldistress
Coldorseasonalallergysymptoms
Allergicreactions
Fever
Muscleachesandpains
Splinterremoval
Minorcutsandrashes
Eyedryness/irritation
Sleepproblems
Studentswillbeadministeredmedicationbasedonnurse’sfindingsandstudent’ssymptoms.
Dormstaffhasspecificwrittenguidelinesfortheabovesymptoms.Intheabsenceofthenurse,dormstaffwillprovide
medicationbasedonthewrittenguidelinesandwillcallthenurseifneeded.
Medicationsneededfortemporaryillness,onashorttermbasiswillbeprovidedtoyourdaughteratnoextraexpense.
Ifyourdaughterrequireslongtermuseofanover-the-countermedication,theschoolwillprovideyourdaughterwith
herownsupply,atyourexpense,tobedispensedonlytoyourchild.Youmaychoosetosupplyyourdaughterwithany
suchmedication.
AsclearlystatedintheStudentHandbook,nomedicationsareallowedtobekeptinastudent’sroom.Thisincludesbut
isnotlimitedtoitemstakenforHealth/Wellness,weightloss,mealsupplements,vitamins,prescriptionandover-thecountermedications.Providingthesemedicationstoyourchildtokeepinherroomcanresultindisciplinaryactionfor
yourchild.
IftherearespecificmedicationsthatyouwouldlikeforyourchildNOTtoreceive,pleaselistthemonthelinebelow.
_____________________________________________________________________
Pleasesignanddatebelow.Youmaymakechangestothisformatanytime.Pleasenotifytheschoolnurseifany
changesaremadeduringtheschoolyear.Anewformisrequiredeachschoolyear.
_____________________________________
Parent/guardiansignature
__________
Date
It is time to register for sports for the 2016-17 academic year. Please go to the Athletics page at the
Linden Hall School website, www.lindenhall.org, and register for sports with Family ID. If you have
any trouble during the registration process, please contact Family ID at [email protected].
Linden Hall and its cooperative program with Warwick High school offer the following sports:
LINDEN HALL SPORTS:
Archery (grades 6-12)
Basketball (Varsity/ Junior Varsity grades 9-12; Junior High grades *7-9)
Dance team (grades 6-12)
Equestrian team (grades 6-12)
Lacrosse club (grades 8-12)
Running club (grades 6-12)
Soccer (Varsity/ Junior Varsity grades 9-12; Junior High grades *7-9)
Tennis (Varsity/ Junior Varsity grades 9-12; Middle School grades 6-8)
Volleyball (Varsity/ Junior Varsity grades 9-12; Junior High grades *7-9)
Girls on the Run (grades 6-8)
*6th graders are permitted to participate on Junior High teams with 7-9th graders however, they
may compete in contests against NON-PIAA teams only.
WARWICK SPORTS - Linden Hall has a PIAA (Pennsylvania Interscholastic Athletic Association)
cooperative program with the local public high school in sports. Linden Hall students can
participate at Warwick in sports that Linden Hall does not offer:
All Sports at Warwick are offered for 9-12 graders only (Varsity/Junior Varsity)
Cross Country
Field Hockey
Bowling
Swimming
Lacrosse
Softball
Track and Field
Please read carefully to find registration deadlines for your sport. In addition, please read carefully
for all fee requirements and required pre-participation forms.
REGISTRATION DEADLINES:
August 1 – Soccer, Tennis (Varsity/JV ONLY), Volleyball, Field Hockey, Cross Country
August 29 – Running Club, Dance Team
September 5 – Equestrian Team, Archery
November 1 – Basketball, Swimming, Bowling
February 1 – Lacrosse, Softball, Track and Field, Middle School Tennis, Girls on the Run
PRESEASON PRACTICES: Students participating in the sports of Soccer (Varsity/JV/JH); Tennis
(Varsity/JV); Volleyball (Varsity/JV/JH); Cross Country (Varsity/JV at Warwick), and Field
Hockey (Varsity/JV at Warwick), please plan to arrive at Linden Hall by 2:00 PM on August 14th
for the start of testing, team organizational meetings and practices. All boarding students will stay in
the dorms at Linden Hall during preseason. Day students may stay in the dorms if there is space available.
Attendance at all practices and team activities is required. Preseason practice/meeting schedules will be
distributed to families as soon as possible.
PRE-PARTICIPATION PAPERWORK AND SPORTS PHYSICALS: All student-athletes are
required to complete the PIAA Comprehensive Initial Pre-participation Physical Evaluation (CIPPE)
which is comprised of 6 sections. If you complete the ONLINE REGISTRATION, you will be
completing sections 1-5 of the CIPPE forms. You DO NOT have to complete the hard copies to turn into
the athletic department. The exception to that is if you are playing a sport at Warwick in which case,
students are required to complete ALL sections 1-6 of the PIAA CIPPE forms and turn in the hard
copies.
ALL student-athletes are REQUIRED to have a PIAA sports physical. PHYSICALS MUST BE
COMPLETED AFTER JUNE 1, 2016. Section 6 is the PIAA Comprehensive Initial PreParticipation Physical Evaluation and Certification of Authorized Medical Examiner. The doctor
who performs the physical must complete Section 6. PLEASE UPLOAD A COPY OF SECTION 6
TO YOUR ONLINE REGISTRATION PAGE by the registration deadline for your sport. **PLEASE
BE AWARE THAT YOU WILL NEED TO BRING A COPY OF SECTION 5 WITH YOU TO THE
PHYSICAL EXAMINATION FOR THE DOCTOR TO REVIEW. There is a link to the PIAA CIPPE
forms on the right of the registration page.
ALL INTERNATIONAL STUDENTS are required to have sports physicals in Pennsylvania.
Linden Hall will offer on campus physicals for International students. There is a $15.00 fee for on
campus sports physicals. On campus sports physicals are reserved for International students. We expect
that all domestic students will complete their physicals by the registration deadlines, however, if there is
space available, they may get their physical on campus. Physicals for students whose seasons begin on
August 14th will take place on August 15th, August 18th and August 23rd on campus. Physicals for
students whose seasons begin after August 14th are TBA. No student-athlete may participate in any form
of practice session until physicals are complete!
WARWICK SPORTS: If you are registering to participate in a sport at Warwick, you are required to
complete the hard copies of sections 1-6 of the CIPPE forms. You must also complete the Warwick
Student Extra-Curricular Activity form and the Warwick Athletic Participation Form. Warwick school
district requires you to pay a $50.00 participation fee. All forms must be uploaded to your registration
page by the registration deadline for your sport. All fees must be paid by the registration deadline
for your sport. You can find all forms at the links to the right of the registration page.
9th GRADERS - JR. HIGH VS. JV/VARSITY: If you are a ninth grader, you will play on the Junior
High team (JH) or the Junior Varsity (JV)/ Varsity Teams. Please register for one of the teams. The
coaches will place you on the appropriate team based on the needs of the program and based on their
evaluation of your skill, athleticism, knowledge of the sport and experience.
6th GRADERS - Sixth graders may register for junior high teams in the sports of Volleyball, Soccer and
Basketball. Sixth graders may attend all practices and may play in contests that are NOT against PIAA
opponents. Sixth graders will not be permitted to play in contests against PIAA opponents.
NEW DAY STUDENTS AND NEW INTERNATIONAL STUDENTS planning to participate in
JV/Varsity Soccer, JV/Varsity Tennis, JV/Varsity Volleyball or JV/Varsity Basketball: If you are a
new day student or a new International student going into grade 10, 11 or 12 you, your parents and the
principal of your previous school must complete the PIAA transfer waiver forms which can be found on
the right on the registration page. The student/parents must complete SECTIONS 2-3 and the former
school principal must complete SECTION 5. Once those three sections are complete, please turn in to
Dina Henry, Director of Athletics, no less than 2 weeks prior to the start of your season.
SAVE THE DATE FOR THE 2017-18 SEASON! Next year the first day of pre-season will be Sunday,
August 13th, 2017. It is required for all student-athletes to arrive to campus by 2:00 that day for the
following sports: Varsity/JV Soccer, Jr High Soccer, Varsity/JV Tennis, Varsity/JV Volleyball, Jr.
High Volleyball, Varsity/JV Cross Country (at Warwick), and Varsity/JV Field Hockey (at
Warwick).
PHYSICAL EDUCATION REQUIREMENT:
9th – 12th grade - two credits, awarded as 0.5 credits each year for participation in at least one
interscholastic sports team or physical activity elective.
6th – 8th grade - two credits, awarded as 0.5 credits each year for participation in at least one
interscholastic sports team and physical education class.
Physical Education is required each year for every student at Linden Hall. The requirement for upper
school students is satisfied by participation on a team or club sport at Linden Hall or through the
cooperative program at Warwick High School. Team levels include Varsity and Junior Varsity (both at
Linden Hall and Warwick for 9-12 graders), Junior High (at Linden Hall for 9th graders), and Club (at
Linden Hall 9-12 grade). If a student does not play a season of a sport, she must complete a Linden Hall
designated after-school activity twice a week throughout the year; options include riding lessons and
dance.
Middle School students are enrolled in yearlong physical education classes twice a week and may
additionally participate on teams or club sports. Junior High and Club teams are offered for middle school
students. During the team or club season, including the Girls on the Run program, middle school students
are not required to attend Physical Education classes with the exception of attending the Archery unit in
September to fulfill Linden Hall's obligation to the National Archery in the Schools Program.
Parent/Guardian Communication Information Sheet
Student Name _____________________________________________________________________
(First or Given Name)
(Last or Family Name)
(Nickname)
Date of Birth: _________/ ________/ __________
(Month)
(Day)
(Year)
Day
5 Day Boarding 7 Day Boarding
Linden Hall frequently uses multiple methods of communicating information to families. Please provide the information
below and select the methods of communicating which best suit your household.
Parent/Guardian (1)
Name: _______________________________________________________________________________
Relationship: __________________________________________________________________________
 Email: ____________________________________________ *One Call (for emergency or weather delay/closing alerts)
 Cell Phone: ________________________________________ *One Call (for emergency or weather delay/closing alerts)
Text Permitted
 Home Phone: _________________________________  Work Phone: ___________________________________
Parent/Guardian (2)
Name: _______________________________________________________________________________
Relationship: __________________________________________________________________________
 Email: ____________________________________________ *One Call (for emergency or weather delay/closing
alerts)
 Cell Phone: ________________________________________ *One Call (for emergency or weather delay/closing
alerts)
Text Permitted
 Home Phone: _________________________________  Work Phone: ___________________________________
* One Call is our automated messaging system. If you elect to participate, emails and/or texts can be sent to you when
messaging is available. You will receive a text that requires action for you to “opt in” and may elect to opt out of
receiving texts at any time.
Student Cell Phone Registration
Student Name: _____________________________________________________
Day Boarding
Cell Phone Description: ______________________________________________________________________
Brand and Color
Cell Phone Number: _________________________________________________________________________
Linden Hall Cell Phone and Electronic Devices Policy
(including, but not limited to, iPads, Computers, Skyping, etc.)
Cell phones, in addition to their convenience, can enhance personal safety when traveling off campus. They can also
create distractions in our school community. Students are permitted to have cell phones if they use them discreetly and in
compliance with the guidelines set forth below. In general, the School expects anyone using a cell phone to not impose
her private conversations or noise of the phone’s ringing on others.
In addition, parents should not call their child during the academic day or during quiet dormitory hours. In the event the
parents must reach their child, they may call the reception desk at 717-626-8512 or the Honeycutt Desk Cell Phone at
(717) 201-2655.
Please see the Linden Hall Student Handbook (online) for more information.
1. Students must register their cell phones and telephone numbers with the Student Life Office.
2. Cell phones/technology should never interrupt academic or school gatherings. Upon entering a classroom, all
cell phones/technology must be stowed and silenced: any that are out and in use are subject to confiscation.
Phones may not be used in classrooms, the library, the chapel, the theater, or the gymnasium during the
academic day or during school functions. Cell phones, iPods, iPads, etc., are never allowed in the dining room.
3. Cell phones may be used in common areas like Honeycutt and the dorms before lights out only.
4. Students may not use cell phones while driving. Violations of this rule may also jeopardize driving privileges.
5. Linden Hall is not responsible for lost phones. The school will in no way be responsible for charges that are
incurred by students or by unauthorized users.
6. Cell phones are not allowed in study hall.
7. Cell phones, computers, iPads, etc. may not be used for any reason after lights out.
NOTE: Using technology after lights out will incur the same disciplinary action and the student's technology will be
confiscated on the first offense. If necessary, allowances can be made for students to temporarily use technology for
academic use during the day. The computer lab is available to students.
If a student disputes the confiscation of her phone, she should turn in the phone to the Adult on Duty and speak with the
Dean of Students or Director of Residential Life at her first opportunity.
“I have read Linden Hall's cell phone policy and the notes concerning the use of other technology. I acknowledge that
it is my responsibility to abide by all the rules governing cell phone and the use of other technology, and I understand
the consequences if I misuse my cell phone or computer while at school.”
__________________________________________
Student Signature
___________________________
Date
Linden Hall Off-Campus Day or Overnight Trip Permission and Release Form
Linden Hall (the “School”) offers weekday and weekend off-campus day or overnight trips for students of all grades levels, and
encourages all students to participate. Participation in off-campus day or overnight trips is voluntary. Your child will not be
permitted to participate in any off-campus day or overnight trips unless this Permission and Release Form (the “Form”) is signed.
This Form must be signed and initialed, where indicated, by the parents and/or legal guardians of the children participating in the
Trips, as well as all trip participants who are 18 years of age or older. If this Form is executed by only one parent or guardian, that
individual certifies that he or she has sole legal custody of the child. In addition, the Student Acknowledgment attached to this Form
must be signed by the parents and/or legal guardians of the child participating in the trips.
I.
PARENTAL PERMISSION AND CONSENT TO PARTICIPATE
As a custodial parent or legal guardian (the “Parent”) of ______________________________________ (please print your child's full
name) (the “Child”), I have given my Child permission to participate in off-campus day or overnight trips, which may include, but not
be limited to, destinations like shopping malls, movie theaters and bowling alleys, and all of the activities associated with them
(collectively referred to herein as the “Trips”).
By signing this Form, I acknowledge that I have had the opportunity to ask questions and obtain whatever information I require to
fully inform myself about each of the Trips offered by the School. I am satisfied as to the adequacy and safety of the arrangements
for each of the Trips. I am also familiar with the mental and physical health of my Child and my Child’s ability to travel and
participate in the Trips offered by the School. My permission for my Child to participate in the activities is based upon my belief that
my Child has the maturity and self-confidence to be able to respond appropriately to any challenges that my Child may encounter
during the Trips.
II.
PARENTAL RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT
I hereby understand and agree that there are certain risks specifically related to the Trips that my Child will take, and that all travel
can be dangerous and involves many risks of serious injury and even death. I also understand and agree that there are risks to my
Child’s person and property involved in staying in places of public accommodation and/or with home-stay families. I also
understand and agree that although the leader of the Trip as designated by the School (the “Trip Leader”) and other faculty/staff will
chaperone the Trips, my Child may be unsupervised at times during my Child’s participation in the Trips.
In consideration of my Child being permitted to participate in the Trips, I agree, on my own behalf and that of my Child, to forever
release, acquit, discharge, covenant to hold harmless and covenant not to sue the School, its trustees, employees, representatives,
agents, volunteers, all related to or associated with the School, and all other individuals and organizations assisting or participating
in the Trips, (all collectively referred to herein as “Releasees”), from any and all claims, suits, liabilities, actions and causes of action,
including, but not limited to, claims of negligence on the part of Releasees, which I or my Child or our heirs, legal representatives,
successors, conservators and assigns may have, now or in the future, which arise directly or indirectly out of my Child’s participation
in the Trips.
I hereby also agree, on my own behalf and on behalf of my Child, to indemnify Releasees from and against any and all claims, suits,
actions, causes of action, including, but not limited to, claims of negligence on the part of Releasees, and liabilities, including
attorneys’ fees, by any person (including without limitation my Child and either of us) resulting directly or indirectly from my Child’s
participation in the Trips, including, but not limited to, injury of any person caused by my Child or for damages to or destruction of
any property caused by my Child.
I recognize and appreciate the risks and danger associated with my Child’s participation in the Trips, including, but not limited to,
risks associated with travel, the potential negligence of Releasees, and participating in the daily activities of the Trips. I hereby
assume the risk of any and all losses and damages, including, but not limited to, personal injury and the potential negligence of
Releasees, which my Child may incur as a result of participating in the Trips.
I recognize that general social and political conditions and circumstances may affect the Trips and are outside of the School’s control
and have agreed, with knowledge of those conditions and circumstances, to allow my Child to participate in the Trips and to assume
the risks that I am assuming by this agreement.
August 2014
1
The release, assumption of risk and indemnity provisions contained above include any property or personal loss or damage, or
other loss or damage caused or alleged to be caused, in whole or in part, by the ordinary negligence (but not gross negligence) of
Releasees.
III.
PARENTS’ FINANCIAL RESPONSIBILITY AND WARRANTY OF INSURANCE
I understand that the School has made financial commitments based on my Child’s anticipated participation in the Trips.
Accordingly, I understand and agree that I will be responsible for the cost of my Child’s participation in the Trips, regardless of
whether or not my Child participates in it/them. Neither I nor my Child will have the right to a refund of any monies paid or owed
for the Trips, including, but not limited to, monies paid for accommodations, meals, transportation and activities associated with the
Trips.
I understand that the School reserves the right to cancel or reschedule the Trips at any time, up to and including the time of the
scheduled departure and to recall any Trips in progress, for any reason as deemed appropriate by the School. Should the School
cancel or reschedule the Trips after monies have been paid, I understand that the School will make a good faith effort to obtain
reimbursement of such monies. However, I understand and recognize that the Releasees are under no obligation to provide
reimbursement of any amounts paid. I agree to forever release, acquit, discharge, covenant to hold harmless and covenant not to
sue Releasees for any financial losses that I or my Child may incur in connection with any cancellation, rescheduling or recalling of
the Trips.
If for any reason my Child is expelled from the Trips or fails to complete the Trips, I agree to pay all costs associated with returning
my Child home, including, but not limited to, costs of transportation for my Child and a chaperone. I further agree that I will not be
entitled to any refund whatsoever as a result of my Child’s expulsion from the Trips or my Child’s failure to complete the Trips. I
agree to reimburse and indemnify the School, its trustees, employees, representatives, agents and volunteers for any costs and
expenses incurred in providing for my Child’s return home and for any other services related to the special or emergency needs of
my Child that the School, in its sole discretion, deems necessary.
Understanding the risks associated with my Child’s participation in the Trips and the possibility of additional risks of which neither
the School nor I nor my Child may be aware, I represent and warrant that I have enrolled my Child in any and all insurance, including,
but not limited to, health care, accident, kidnap, travel and personal property insurance that I believe, in my sole judgment, is
necessary to protect my Child and my Child’s interests while participating in the Trips.
IV. MEDICAL INFORMATION AND TREATMENT AUTHORIZATION
If there are any changes in my Child’s health in the past 12 months and/or to my Child’s medical information currently on file with
the School Nurse, I agree to update such health and medical information as necessary through Magnus Health and/or the School
Nurse’s Office.
If my Child will need to take any prescription or over-the-counter medication(s) while participating in the Trips, a copy of this signed
Form together with the appropriate container(s) of medication(s) and any supplies necessary to administer the medications will be
provided to the School Nurse prior to the commencement of my Child’s participation in the Trips. All medications will be in properly
labeled pharmacy or manufacturer provided containers. I am responsible for packing students’ EpiPens, Benadryl, Inhaler, and any
emergency medications. I understand that the School Nurse will administer or supervise the administration of medications to my
Child as needed. In case the School Nurse is unavailable to administer the medications to my Child, I understand that the School
Nurse will generally delegate the administration of medications to the Trip Leader, but I understand that the Trip Leader is not a
medical professional. By signing this Form, I am authorizing the Trip Leader to administer the medication(s) to my Child. It is
expected that my Child will self-administer my Child’s own medication(s) under the supervision of the School Nurse or the Trip
Leader.
In consideration of the administering or assistance in administering medications, I forever release, acquit, discharge, covenant to
hold harmless and covenant not to sue Releasees from any and all claims, suits, liabilities, actions and causes of action, including, but
not limited to, negligence of Releasees, which I or my Child or our heirs, legal representatives, successors, conservators and assigns
may have, now or in the future, which arise directly or indirectly out of the administering or assistance in
In rare instances, a medical or dental emergency requiring treatment arises in which written consent by parents or guardians is
legally required, but the parents or guardians cannot be reached. In this event, and in order to avoid delay that might jeopardize the
life or recovery of my Child, I grant the following permission, with the understanding that efforts will be made to contact me in case
August 2014
2
of an emergency.
In my capacity as the custodial parent and/or legal guardian of ______________________, a minor participating in the Trips, I
hereby appoint the Trip Leader, my true and lawful representative for the purposes of taking all steps necessary to ensure the
proper care (including medical, dental, surgical and hospital care) of my Child while my Child is participating in the Trips, and to
execute any and all necessary documents and papers requested by any person or entity prior to treatment of or rendering of care to
my Child. I authorize physicians and other medical personnel to provide medical and other care to my Child while my Child is on the
Trips, including, but not limited to, examining, treating, and/or prescribing medication(s) for my Child’s care, as needed.
I understand that the Trip Leader is not a trained medical professional and that the Trip Leader or another representative of the
School will consult with me concerning the reasons for and the effects of all such care, to the extent possible under the
circumstances. Recognizing that it may be difficult to reach me, I authorize the School and the Trip Leader to permit
commencement of treatment when, in the professional judgment of the physicians, dentists or other medical personnel involved,
such treatment is medically necessary or advisable, even if I have not yet been consulted. In authorizing such treatment, I agree to
accept the determination of the treating physician, dentist or other medical personnel that the treatment or examination rendered
was medically necessary or advisable to protect the life, health or mental well-being of my Child. Additionally, I hereby grant my
authorization and consent for the Trip Leader, to administer general first aid treatment for any minor injuries or illnesses
experienced by my daughter, and a minor, while participating in the Trips.
I, the undersigned, do hereby solemnly swear that I have the legal custody of _____________________. I have read this Form in its
entirety and I have satisfied myself that I understand what it means. I hereby expressly agree that the provisions contained in this
Form are intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Pennsylvania and that if any
portion hereof is held invalid or unenforceable, I agree that the balance shall continue in full legal force and effect. By signing this
Form, I affirm that I have decided to allow my Child to participate in the Trips with full knowledge that Releasees will not be liable to
anyone for any personal injuries or property damage my Child may suffer while participating in the Trips.
Signature of Parent #1: ________________________________________________ Date: ____________
Print Full Name of Parent #1: ____________________________________________________________
Address of Parent #1: ___________________________________________________________________
Signature of Parent #2: _______________________________________________ Date: _____________
Print Full Name of Parent #2: ____________________________________________________________
Address of Parent #2: ___________________________________________________________________
Signature of Child if 18 or Over: ________________________________________________________
August 2014
3
Student Off-Campus Day Trip Acknowledgement Form
By signing below, I acknowledge that I have been provided with detailed information about the Trips to (as defined
above), including the description of the Trips, arrangements for my transportation, meals and activities, and the
Permission and Release Form, to which this Student Acknowledgment Form is attached. I will participate in any and all
trip orientations, read the information provided, and take the opportunity to ask questions and obtain whatever
additional information I require to fully inform myself about the Trips. I understand the risks involved in participating in
the Trips and that there may be additional risks of which neither Linden Hall (the “School”) is aware nor I am aware. I
have voluntarily decided to participate in the Trips and accept the risks involved. I have obtained my parents’ consent to
participate in the Trips and both my parents and I believe that I have the maturity and self-confidence to be able to
respond appropriately to any challenges that I may encounter during the Trips.
I recognize that safe participation in the Trips requires that I exercise my own good judgment. I will comply with the
rules and regulations established by the School and its authorized representatives prior to and during the Trips, including
complying with the School’s Parent/Student Handbook (the “Handbook”) and all applicable laws. I will follow the
direction, guidance and advice from the Trip Leader and chaperones, and understand and agree that the following may,
at the Trip Leader’s direction, be cause for my being sent home, without question or discussion, at my own expense:








Violating any federal, state or local law that may be applicable.
Violating any of the policies included in the Handbook.
Leaving the group without permission.
Consuming, purchasing or possessing alcoholic beverages, tobacco products or illegal drugs.
Purchasing or possessing pornography or weapons.
Using illegal drugs or misusing over-the-counter prescriptions.
Operating a motor vehicle or other motorized device.
Engaging in behavior that the Trip Leader considers to be inappropriate, disturbing or offensive.
I understand that if the School becomes aware that any of the above offenses have been committed, my parents will be
notified and the School will follow-up with its disciplinary process. Additionally, depending on the circumstances, my
parents may be required to pick me up from the Trip at their expense. I further understand that my conduct during the
Trips may serve as the basis for disciplinary action or expulsion from the School. By signing this form, I acknowledge that
I have read and understand what I am signing, and I am agreeing to all of the provisions listed above.
Signature of Student: ________________________________________________ Date: ______________
Print Full Name of Student: ______________________________________________________________
I am the parent of the above named student (the “Child”), I have read the foregoing Student Acknowledgment (including
such parts as may subject me to personal financial responsibility), and I am and will be legally responsible for the
obligations of my Child as described in this Student Acknowledgment, and agree, for myself and for my Child, to be
bound by its terms.
Signature of Parent #1: ________________________________________________ Date: ____________
Print Full Name of Parent #1: ____________________________________________________________
August 2014
Public School Bus Transportation Form 2016-2017
Student Name: _____________________________________________________________________________________
Date of Birth: _______________________ Grade: ____
School District: _____________________________________________________________________________________
Parent/Guardian Contact 1:
Name: ___________________________________________________________________________________________
Address: __________________________________________________________________________________________
City: ____________________________________________, State: ________, Zip: _______________________________
Home Phone: ___________________________
Cell: ___________________________________
Email: ________________________________________________________________________
This information will be provided to your local, residential school district, for the purposes of their planning a *bus route
for your daughter. Please note that Linden Hall is not in any way a part of these arrangements, nor does it have any
influence over bus stops, pick up or drop off times, nor the bus drivers.
In the event the public schools are closed while Linden Hall is in session, you will be responsible for providing your own
transportation to and from Linden Hall. In the event of inclement weather or other emergency, please contact your local
school district about busing availability. If your daughter will be absent and not taking public busing, please
communicate that directly to the school district transportation company.
For questions or concerns, please contact your local school district transportation department.
* not all school districts provide public bus transportation to Linden Hall. Please contact your school district for more information.
Student Automobile Policy and Agreement
Day students and residential juniors and seniors may have an automobile on campus with the permission of the
Administration.

All students must use the designated student parking area at all times. This area is the parking lot behind the
Anne Brossman Sweigart Gymnasium.

All students must file an automobile registration form and receive a parking sticker, to be placed on any
automobile they bring to campus.

Day and residential juniors and seniors may use their automobiles to go to and from their homes only, or for
weekend overnights when permission is requested by parents and granted by the Administration.

Day and residential students may not use their automobiles during the school day (not before 3:45 PM) unless
special permission is given by the Dean of Students or Residential Director after consulting with parents. A
student may drive only her own automobile.

Student, parents or legal guardians are responsible for making arrangements for automobile servicing.
Inspections and routine maintenance must be taken care of at home.

Students may transport boarding and day students in their automobiles only with specific permission from the
Dean of Students or Residential Director and signed permission forms by parent(s).

Using an automobile irresponsibly will result in suspension of driving privileges. Repeated or serious infractions
may result in permanent revocation of the driving privilege.

Drivers must restrict their travel to within a 20-mile radius of the school unless special permission from the
Administrator on Duty has been granted in consultation with the driver’s parents.
Student Name: ___________________________________________ Grade_______________
(Printed)
Signature: ____________________________________________________________________
My signature indicates I have read, understand, and agree to the terms of this policy, which can be found in the Linden
Hall Student Handbook.
Make of Car (Toyota,
Chevy, etc.)
Car #1
Car #2
Model of Car
(Corolla, Malibu,
etc.)
Color
License Plate #
Parking Permit
#
Dress Code Information
Linden Hall is currently using Flynn & O’Hara as our uniform supplier. Please visit their website
www.flynnohara.com/register to view and order the uniform online. The complete dress code is available in the Linden
Hall Student Handbook.
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Uniforms must be worn during the academic day unless special exceptions have been made.
Athletes may wear their team uniforms on game days during their season.
Students who participate in riding must wear the Linden Hall uniform and change for lessons or follow the
Linden Hall Riding program dress code.
Athletes who participate in our Warwick co-op program may wear team uniforms on game days during their
season.
Athletes are not permitted to wear warm-ups during the school day except on Spirit Wear Days or on game
days.
On Spirit Wear Days, students are permitted and encouraged to wear Linden Hall spirit wear (any Linden Hall
clothing garments, t-shirts, etc.) They may also wear jeans, pants or skirts during spirit wear “dress-downs.” If a
student does not wish to wear spirit wear, she may wear the school uniform.
Students are not permitted to wear sweatpants at any time.
Colored/patterned leggings are not permitted with the school uniform; only navy blue, black, white, or nude
colors are permitted.
Shorts are only permitted if they are the approved Linden Hall uniform shorts and are not permitted between
October 1 through May 1.
Students may wear a LH cardigan sweater, pullover, or fleece over any Linden Hall uniform shirt (polo or button-up)
at any time during the school year. No other sweatshirts or jackets are permitted in the academic buildings. Other
outerwear must be stored in dorm rooms or lockers.
Though each student will have varying wear and tear, we recommend using the following guideline (Laundry facilities
are available for boarding students on campus and scheduled use to ensure good hygienic practices):
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1-2 kilts
1-2 pairs of khaki pants
2-3 short-sleeved and/or long-sleeved polo shirts
1 button down white shirt
1 cardigan/pullover sweater
Additionally, every student is expected to wear a white dress and white shoes for graduation ceremonies at the end of
the year. More details are available in the Student Handbook. Occasionally, students will be asked to “dress-up” for
school events – the school uniform is also permitted for these events.
SAVE THE DATE
IN-SCHOOL TRUNK SHOW
LINDEN HALL
IN-SCHOOL UNIFORM SALE FOR THE FAMILIES OF LINDEN HALL.
A COMPLETE LINE OF SIZES AND TRY ONS WILL BE AVAILABLE FOR ALL SCHOOLS.
ANY OUT OF STOCK ITEMS WILL SHIP DIRECTLY TO YOUR HOME WITH FREE SHIPPING.
DATE & TIME:
August 24th, 2016
9:00AM - 3:00PM
LOCATION:
Linden Hall
212 E. Main Street
Lititz, PA 17543
Visit your custom uniform shop page
to shop anytime:
www.flynnohara.com/school/pa785
Visit us at our closest serving retail
location:
869 Eisenhower Boulevard
Harrisburg, PA 17111
(717) 939-5600
Please note: Orders must be placed before August 1 to ensure delivery by the first day of school!
ABOUT FLYNN’OHARA
WARRANTY INFO
FlynnO’Hara Uniforms is a Philadelphia-based
supplier and retailer of high-quality school uniforms and gym
wear. We are family owned and operated, servicing over 1500
schools across the United States.
We’re so confident in our products that we offer a School Year
Guarantee: If you’re not satisfied with the way an item is holding up within a year of purchase, we’ll replace it.
CONTACT FLYNNO’HARA: 800-441-4122
WWW.FLYNNOHARA.COM
2016 PRICING
Girls
Year-Round Uniform
Grades 6-12
Blackwatch Plaid Wrap Around Kilt (CHILD: $46.50) (TEEN: $47.25)
Navy Short Sleeve Banded Bottom Shirt w/Logo (YOUTH: $23.50) (ADULT: $27.50)
White Short Sleeve Banded Bottom Shirt w/Logo (YOUTH: $23.50) (ADULT: $27.50)
Navy Long Sleeve Banded Bottom Shirt w/Logo (YOUTH: $25.75) (SM-XXLG: $29.50)
White Long Sleeve Banded Bottom Shirt w/Logo (YOUTH: $25.75) (SM-XXLG: $29.50)
White Long Sleeve Buttondown Collar Shirt w/Logo (YOUTH: $22.75)
White Long Sleeve Buttondown Collar Blouse w/Logo (ADULT: $25.75)
Khaki Flat Front Girls Slacks (04-06XC: $23.50) (07-16RS: $26.50) (JR: $30.50)
Navy Cotton V-Neck Sweater w/Logo (YM-YXL: $46.75) (AXS-AXL: $50.50) (XXL-XXXL: $54.50)
Green V-Neck Pullover Sweater w/Logo (YM-YXL: $31.25) (AS-AXL: $35.00) (XXL-XXXL: $39.00)
Navy V-Neck Sweater Vest w/Logo (YM-YXL: $29.50) (AS-AXL: $31.25) (XXL-A7X: $35.00)
Green V-Neck Sweater Vest w/Logo (YM-YXL: $29.50) (AS-AXL: $31.25) (XXL-XXXL: $35.50)
Navy V-Neck Cardigan Sweater w/Logo (YM-YXL: $34.25) (AS-AXL: $36.75) (XXL-XXXL: $40.75)
Green V-Neck Cardigan Sweater w/Logo (YM-YXL: $34.25) (AS-AXL: $36.75) (XXL-XXXL: $40.75)
Navy Polyster Ladies Blazer w/Logo (ALL SZS: $74.00)
Navy Ladies Full-Zip Polarfleece Jacket w/Logo (WOMENS: $45.00)
Navy Polar Fleece Jacket w/Logo (YOUTH: $39.50) (AS-A4X: $44.50)
Navy Opaque Nylon Knee-Hi (S-M-L: $5.00)
Green Opaque Nylon Knee-Hi (S-M-L: $5.00)
Navy Orlon Knee-Hi (S-M-L: $5.00)
Green Orlon Knee-Hi (S-M-L: $5.00)
Navy Opaque Tights (CHILDS: $8.75) (JUNIORS: $9.50)
79 Blackwatch Plaid Elastic Headband (NA: $8.50)
Black Cotton/Lycra Short (YOUTH: $12.50) (ADULT: $14.50)
Girls
Spring/Fall Uniform
Grades 6-12
Khaki Girl's Twill Walking Shorts (07-16R&S: $23.50) (3-23 JR: $24.50)
OFFICE#__________________
NewBoardingStudentProfile
2016-2017Term
Name__________________________________________
CurrentGrade______________
WelcometotheResidentialCommunityatLindenHall!
Livinginacommunityisanimportantpartofyoureducationalexperience.Livingwithgirlsfrom
differentculturesandbackgroundsisauniqueprivilegeforboardingschoolstudents.Yourstudent
handbookgivesyoumanyguidelinesforgettingalongwithyourroommate.Aswepreparetoassign
youyourroomandroommate,wewouldliketoknowmoreaboutYOU.
Considercarefullyandcheckallthatapply:
___Iliketogotobedassoonaspossible
___Ilikelatelights
___Istudyafterhours ___Igetupearlytostudyorexercise
___Acleanroomisveryimportant
___Acleanroomisn'timportanttome
___Iamasoundsleeper
___Iamalightsleeper
___Imusthaveadarkroom
___Ipreferanightlight
___Iuseairfresheners/perfumes
___Iamallergictofragrances
___Ilikeaquietroom ___Ipreferaroomthatisfullofactivityandsound
___Irarelyusemycellphone ___Iusemycellphonealot
___ISKYPEregularly
___IrarelySKYPE
___Iliketowatchmoviesonline
___Ineverwatchmoviesonline
___Irarelyeatinmyroom
___Iamalwayseatinginmyroom
___Showeringandpersonalhygieneareveryimportanttome
___Showeringandpersonalhygieneareimportant,butnotthatimportant
___I'mnotreallyintopersonalhygiene
Listanyotherissuesthatareimportanttoyou.(NOTE:Englishisthecommonlanguageandmustbe
spokenwhenincommonspaces.Werealizethatmanyinternationalstudentsdesiretolivewithan
Americanroommate.Itisimportanttounderstandthatourstudents’schedulesareverybusy.Youwill
notspendmuchtimeinyourroom!WhilewecannotguaranteeanAmericanroommate,weencourage
allstudentstobeengagedinactivitieswheretheywillinteractwithgirlsfrommanydifferentcountries.
Athleticteams,musicalanddramateams,andclubswillbeimportantvenuesforimprovingyourEnglish
skillsandlearningaboutdifferentcultures!)
PLEASECOMPLETEANDRETURNASSOONASPOSSIBLEBEFOREJULY15.WEBEGINASSIGNINGROOMS
INMAY.RETURNINGSTUDENTSMAYREQUESTSPECIFICROOMMATES.
WhattoBringChecklist
IMPORTANTITEMS
•Sheets(twin-size)
•Pillowandpillowcases
•Clotheshangers
•Bedspread/comforter
•Blanket
•Towelsandwashcloths
•Rainandcoldweathergear
•Haircarenecessities •Dressesorskirtsforspecialoccasions
•SmallDesklamp
•Alarmclock •Combinationlockforcloset(required)
•ShowerCaddy
•Watch(therearenoclassbells)
•AthleticSneakers
•Laundrysupplies
•Computer
•Personalhealthcareitems
OPTIONALITEMS
•iPods,MP3players
•Sleepingbag •Throwrugs/carpet(nolargerthan9x12)
•Skis,skates,tennisracquet,softballglove,etc.
•MiniBooklight
•Refrigerator(nolargerthan1.8cubicfeet)
•Posters,pictures,etc. •Flashlight
•Smalltrashcan
TheSchoolstronglyrecommendsthatallbelongingsbelabeledwiththestudent’sname.
NOTE:Helmets,kneeandelbowpadsmustbewornwhenskating.
WHATTOLEAVEATHOME
•Television
•Heatlampsorsunlamps
•Portablespaceheaters
•Electriccookingappliances
•Posters,containers,ordecorationsadvocating
drugs,alcohol,orpornography
•Incense,candles,matches,lighters NOTE:Valuables(jewelry,cash,etc.)Safetyandsecurityisveryimportanttous.Werequirestudentsto
keeptheirdoorsandclosetslocked.Inaddition,wesuggestthatlargeamountsofcashshouldbekeptin
abankordepositedwiththeschool’sBusinessOffice.
BoardingStudentTravelInformation
WelcometoLindenHall!
WearegladthatyouhavechosentobeapartofourLHfamily,andwearelookingforwardtoyour
arrivalinAugust.Youwillsoonhaveendlessopportunitiestomakenewfriends,exploreothercultures,
andlearnmoreaboutyourselfandotherteenagegirls.Ontheweekends,youwillhavetheopportunity
tovisitnearbymuseums,cities,shoppingmalls,andparks.LancasterCountyisideallylocatedinSouth
CentralPennsylvaniaandishometoaward-winningculturalopportunities,sports,andmore.Lifeat
LindenHallistrulyanadventure,andyouwillwanttoexperienceallwehavetooffer!
Foryourconvenienceandcosteffectiveness,weareaskingourinternationalstudentstobooktheir
flightsandplantoarriveatHarrisburgInternationalAirportonTuesday,August23,2016.Uponarrival
tothisairport,astaffmemberwillmeetyouandtransportyoutothecampuswhichisonly45minutes
away.
IfyouareunabletoarriveonAugust23ormustuseanotherairport,pleasecontactExpressions
LimousineServicetomaketravelandpaymentarrangementsbyphoneat717-556-5466orbyemailat
[email protected].
Ifyourdaughteristheageof16andunder,pleasenotethatmanyairlinesmayrequirehertoflyasan
“unaccompaniedminor”.Thisrequiresspecialnotationonherticket(withanattachedfee)and
designatednamesofthepersonsdeliveringhertoandpickingherupfromtheairportflightgate.For
thespecificnameontheLindenHallendofhertravelyoumayuse“ExpressionsLimousine”asthe
designatedname.Pleasebesuretocheckdirectlywiththeairlinewhenyoupurchaseyourtickets.Any
questions,feelfreetocallLindenHall,at717-626-8512,andaskfortheAssistantResidentialDirector,
Mrs.TawniaPrice([email protected]).
Sincerely,
DennisL.Foreman,ResidentialDirector