2015 Welcome Docs - Vanderbilt Programs for Talented Youth
Transcription
2015 Welcome Docs - Vanderbilt Programs for Talented Youth
VSA 2015 Information WELCOME INFORMATION CHECKLIST FOR 2015 To Vanderbilt Summer Academy Students and Families: We have provided this checklist to aid you in completing and returning your VSA welcome documents. Receipt of these documents is required for participation in VSA. Please take a moment to verify the items listed below are included in this Welcome Packet. Additional copies of these forms may be downloaded at: http://pty.vanderbilt.edu/students/vsa/admitted/ The following items should be returned AS SOON AS POSSIBLE, but no later than April 10, 2015 for Sessions II & III; May 8, 2015 for Session I: ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ 1. A check for any remaining tuition balance, if applicable 2. Permission & Release (2 pages) 3. Authorization to Consent to Treatment of a Minor 4. Physician’s Statement of General Health 5. Mental Health Professional’s Statement of General Emotional Health 6. Health History & Front & Back Copy of Student’s Health Insurance Card (6 pages) 7. Student & Parent Agreement of Policies 8. Media & Data Release 9. Transportation Information, w/check for airport transportation, if applicable 10. Areté Options & Selections 11. Student Photo Using the enclosed envelope, please return items 1 through 11 from above to: Vanderbilt Programs for Talented Youth Peabody #506 230 Appleton Place Nashville, Tennessee 37203-5721 ALL ITEMS DUE TO VANDERBILT PTY NO LATER THAN SESSIONS II & III SESSION I APRIL 10, 2015 MAY 8, 2015 Have questions? Please feel free to contact us: Phone: (615) 322-8261 Email: [email protected] PERMISSION & RELEASE Student Name:__________________________________________________________________ My child, the above-named student, desires to participate in the Vanderbilt Summer Academy (hereinafter VSA). I voluntarily assume all risks of this activity on behalf of my child. I recognize that this activity may expose my child to some level of risk of injury. Notwithstanding these risks, I assume them by allowing my child to voluntarily participate in VSA. Further, I hereby: • agree that students will be participating in a residential program on the campus of Vanderbilt University (hereinafter VU). As a participant, the student will be supervised by VU staff and reside at Hank Ingram House on the Vanderbilt Commons. Students will also have access to on-campus recreational facilities and activities; • understand that the activities for the sessions vary but may include the following: classroom instruction, organized recreational and athletic games. For Session III participants only, unsupervised walks off campus are scheduled at designated times and within stated town boundaries. These activities are assumed upon enrollment and participation in VSA is at the risk and request of the student; • agree that students are charged with knowing and abiding by VSA policies as described in VSA publications or as articulated by VU staff. Students who fail to follow VSA policies may be asked to leave the program. If a student is asked to leave, his or her parent or legal guardian will be contacted. The parent or legal guardian must make immediate arrangements to remove the student from campus at the parent or legal guardian’s expense. Students who are asked to leave will not receive a refund of tuition or other fees; • understand that during VSA, students may participate in off-campus field trips. Students who are transported off-campus for activities will travel in vehicles driven by VU staff, other Vanderbilt staff, or hired designees. Students who are off-campus will conduct themselves at all times in accordance with VSA policies and will be accompanied by VU staff or hired designees during trips; • agree that Vanderbilt is not liable for lost, stolen or damaged personal articles. Vanderbilt is also not liable for any consequences of the student’s actions including injury to persons and property, arising during on or off-campus periods, and I accept responsibility for reimbursement either to the injured party or to Vanderbilt for any damages sustained by them due to my child’s actions; • agree that, to the best of my knowledge, the information furnished by or on behalf of the student in connection with the student’s participation in VSA is correct and complete; • give permission for the student to view movies that are rated G - PG 13, as well as in-class films and clips deemed to be of educational value, while participating in VSA. I recognize that a VU staff member will approve of these movies before they are shown in the classroom, residence hall, auditorium, or other setting; • agree that VSA has the right to alter arrangements concerning the location and/or content of the program or travel arrangements if it deems such action is advisable; Return to Vanderbilt PTY by April 10, 2015 for Sessions II & III and May 8, 2015 for Session I. -1 of 17- VSA 2015 Welcome Documents • agree that if the student should suffer an injury or illness while participating in VSA or any other activity, I authorize the employees of VU to use their discretion to have my child treated at or transported to the nearest medical facility and I take full responsibility for that action; • agree to be responsible for any losses (including reasonable attorneys fees and court costs) resulting from my child’s damage, vandalism, littering, or theft of VU property, property of a University community member or campus visitor, or any other property used during VSA. Furthermore, I agree to indemnify Vanderbilt for any loss or damage to the premises, facilities, or equipment during VSA. • understand VU personnel adhere to Tennessee state law on mandatory child abuse reporting to either the appropriate law enforcement agency or the state hotline operated by the Department of Children’s Service. In addition to external reporting, Vanderbilt has a mandatory internal child abuse reporting procedure. If you have reason to believe abuse or inappropriate behavior has occurred concerning a minor participating in a Vanderbilt University program, please consult the program director, or Risk Management (615-936-0660), or report via the Vanderbilt hotline at 866-783-2287. The Tennessee Child Abuse reporting hotline number is 877-237-0004. • agree, in consideration of Vanderbilt allowing my child to participate in VSA, to hold harmless and indemnify Vanderbilt and its trustees, agents, officers, servants, and employees against loss from any and all claims of ordinary negligence, demands, rights, or causes of action of any kind or nature that may hereafter at any time be made or brought by my child, by me or anyone on my behalf, or by any other person having a legal interest therein arising from or by reason of any and all known or unknown, foreseen and unforeseen bodily or personal injuries, damages to property and consequences thereof which may be sustained by my child, in consequence of any accident or injuries on the premises of Vanderbilt or in connection with the activity, except such liability or claim of liability as may result from gross or intentional negligence on the part of Vanderbilt. Said indemnification shall include, but not be limited to, court costs and attorneys’ fees. I (the undersigned parent/legal guardian) understand and agree to the preceding terms regarding the student’s participation in VSA. I certify that the student is capable of participating in VSA and I grant permission for the student to participate in all planned activities. READ BEFORE SIGNING: By signing below, I acknowledge that I am 18 years of age or older and understand that I am entitled to have an attorney of my own choosing to review the Release prior to signing. I have read the foregoing Release in its entirety and understand that I am signing a complete and perpetual release and bar to any and all claims of ordinary negligence as defined above resulting from the participation in this activity by me or my child. If the participant is not 18 years of age or older, this release must be signed by a parent or legal guardian. Parent/Legal Guardian’s Signature __________________________Date: ________________ Parent/Legal Guardian’s Printed Name ____________________________________________ **The policies outlined in this document apply from the date signed to 9/3/2015. Permission & Release -2 of 17- VSA 2015 Welcome Documents AUTHORIZATION TO CONSENT TO TREATMENT OF A MINOR I, the parent/legal guardian of, __________________________________________ Student’s Name __________________________ Student’s Date of Birth an unemancipated minor, who is a participant in the Vanderbilt Summer Academy (VSA), do hereby consent to an X-ray examination, anesthetic, medical or surgical diagnosis or treatment and medical care which is deemed advisable by and is to be rendered under the general supervision of any physician or surgeon on the medical staff of the Vanderbilt University Student Health Center, Vanderbilt University Children’s Hospital or other licensed medical care providers. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or medical care being required and is to serve as specific consent to any and all such diagnoses, treatment, or hospital care which may be deemed advisable. I also understand that VSA does not staff medical professionals. VSA and its staff are not responsible for overseeing student medical needs. I further authorize VU staff to dispense nonprescription analgesics for minor medical problems such as headaches, etc. In addition, I consent to allow the physicians and staff involved in any such treatment to share medical findings regarding this student with VSA program coordinators and staff. READ BEFORE SIGNING: By signing below, I acknowledge that I am 18 years of age or older and understand that I am entitled to have an attorney of my own choosing to review the Release prior to signing. I have read the foregoing Release in its entirety and understand that I am signing a complete and perpetual release and bar to any and all claims of ordinary negligence as defined above resulting from the participation in this activity by my child. If the participant is not 18 years of age or older, this release must be signed by a parent or legal guardian. ___________________________________ Parent/Legal Guardian’s Signature Date:__________________ ___________________________________ Parent/Legal Guardian’s Printed Name **The policies outlined in this document apply from the date signed to 9/3/2015. Permission & Release -3 of 17- VSA 2015 Welcome Documents STUDENT HEALTH HISTORY & DISCLOSURE Please complete all information about your child’s health. Separate forms indicating Consent to Treat and Statements of General Health are also required for submission before a student is eligible to attend the program. Additional information may also be found in the student handbook and the welcome packet. At Vanderbilt Programs for Talented Youth we seek to provide a quality academic and social program to meet the needs of gifted students and to provide a taste of college life prior to matriculation. We ask several questions, many of which may not be pertinent, to ensure that we have appropriate knowledge of each student so that all program participants are actively engaged in a larger academic and residential community that encourages one another and promotes safety, security, and efficacy for all involved. All information provided on this form is strictly confidential and will be treated as such by VSA faculty and staff. We request this information for the health and safety of each student in our program. Failure to disclose the requested information may result in your child being dismissed from VSA without refund. Vanderbilt is committed to principles of equal opportunity and does not discriminate on the basis of race, sex, religion, color, national or ethnic origin, age, disability, military service, sexual orientation, gender identity, or gender expression. Student’s Name: ________________________________ Date of Birth: ____________________ Parent/Legal Guardian: ___________________________________________________________ Preferred Phone Numbers: (____)______________________(____)___________________ Street Address: _____________________________________________________________ City: ____________________________ State: ________ Zip Code: _____________ Alternative Contact Information: We will certainly call parents/guardians in an emergency, but we’ll also call if we have questions about a student’s health. If we cannot reach a parent or guardian, we ask that you provide contact information for someone who knows the student and with whom we can consult. We assume you have spoken to these alternative contacts and they are willing to assist should the need arise. 1) Alternative Contact’s Name: ______________________ Phone: _____________ Relationship to Student: ___________________________________________ 2) Alternative Contact’s Name: ______________________ Phone: _____________ Relationship to Student: ___________________________________________ Student’s Physician: ___________________________Office Phone: _____________________ Student’s Orthodontist: _________________________Office Phone: _____________________ Student’s Dentist: ______________________________Office Phone: ____________________ Other: _______________________________________Office Phone: ____________________ Health History -4 of 17- VSA 2015 Welcome Documents Insurance Information Parents/ Guardians are financially responsible for healthcare costs. All students must have health insurance during their term here. Please the Student Handbook for more information. Insurance Carrier or Plan Name: ___________________________ Group #:__________ Carrier Street Address: _________________________________________________________ City: _______________ State: ___________________________ Zip: ____________ Carrier Phone: _________________________ Name of Insured: _________________________ Relationship to Student: ___________ Policy Holder’s ID Number ______________________________________________________ Front Back Please photocopy and attach the front and back of your insurance card. Health History -5 of 17- VSA 2015 Welcome Documents Allergies Circle "yes" or "no" to the following statements. Explain as indicated. Please write “N/A” if the question does not apply. YES NO Does this student have a food allergy? If yes, please explain (you can tell us about nonmedical dietary restrictions on the next page): YES NO If you answered yes above, does the food allergy cause anaphylaxis or other immediate reaction? If so, please describe the reaction and what is done to manage it: YES NO Is the student allergic to any medications? If yes, please explain: YES NO If you answered yes above, does the medication allergy cause anaphylaxis or other immediate reaction? If so, describe the reaction and what is done to manage it: YES NO Does the student have other significant allergies? If yes, please explain: YES NO If you answered yes above, does the significant allergy cause anaphylaxis or other immediate reaction? If so, describe the reaction and what is done to manage it: Health History -6 of 17- VSA 2015 Welcome Documents General Physical Health This section focuses on your child’s overall physical health. In addition to the information provided here a Physician’s Statement of General Health form is included in this packet to be completed by your physician. Students must be independent in their daily health care. Students in the program should not have medical conditions requiring daily ongoing monitoring or day-by-day management by someone other than the student. Chronic Health Concerns: This student has no chronic health concerns and is capable of full participation in the program. This student has the following chronic health concerns (Mark all that apply): Asthma Headaches Diabetes Menstrual Cramps Frequent Ear Infections Fainting Encopresis Seizure Disorder/ Epilepsy Addiction Eating Disorder Heart Murmur Cardiovascular Disease Hypoglycemia Endocrine Disorder Other: Please explain any marked items, including the impact of the concern on full participation in athletic events, group activities, and classroom learning during VSA: ___________________________________________________________________________________ ___________________________________________________________________________________ Mark “yes” or “no” to the following statements. Explain as indicated. Yes No Has this child had surgery within the past 12 months? If yes, explain: _______________ _______________________________________________________________________ Yes No Does this student have dietary restrictions for non-medical reasons? (Ex: vegetarian, Kosher, halal, etc.?) _______________________________________________________________________ Yes No Will this child be bringing any special equipment for mobility (e.g., wheelchair, walker, cane, crutches, etc.)? If yes, explain any accommodations necessary to navigate campus. ________________________________________________________________________ Please provide any additional information about special needs such as elevator/ramp/wheelchair access, equipment to aid sleeping, hearing aids, crutches, etc. that the VSA staff needs to be made aware of: Note: Students who use special equipment (e.g., hearing aids, walker) during the school year should expect to continue using the same equipment at VSA. Health History -7 of 17- VSA 2015 Welcome Documents Medication Will this student bring any medications (including over-the counter medications to VSA? Y N Please note that we stock most common non-prescription medicines, such as Aspirin and Tylenol, in the VSA office. Medication Name Dose Time(s) Given Reason Comments (e.g. side effects) Example 1 pill AM Noon PM As needed Nausea May upset stomach. Take with food. Medication Policies • Emergency medications, such as inhalers or EpiPens, may be kept in student’s rooms. • For the health and safety of our students, all other medications, including over-thecounter medications, must be checked in with VSA staff and stored in the VSA office. • All medications must arrive in appropriately labeled pharmacy containers. • It is the responsibility of the student to come to the office to obtain his or her medications, as • • • prescribed. Bring enough of each medication to last the entire session. Students taking medications for psychiatric reasons should be on a stable medication regime, ideally having been on the same medications(s) at the same dose for the three months prior to a student’s arrival to VSA. Vanderbilt Summer Academy is not responsible for missed or incorrect doses. We are a repository for the safe-keeping of medication only. Over the Counter Medication The following over-the-counter medications are stocked in the VSA office and the Vanderbilt Student Health Center. Below is a sample of medications stocked in the VSA office, please list any medications your student is not permitted to take. Stocked medications may include but are not limited to: My student must not take: Acetaminophen (Tylenol) Antacids (e.g. Tums, Pepto, Alkaseltzer) Oral Allergy Medication (e.g. Benadryl, Sudafed) Topical Ointment (benadryl cream, hydrocortisone) Ibuprofen Cough Drops Tinactin Triple Antibiotic Cream Chloraseptic Throat Spray Cold Medication (e.g. Nyquil/Dayquil) Health History -8 of 17- VSA 2015 Welcome Documents Social, Emotional, Behavioral, and Mental Health This section asks about the student’s social, emotional, behavioral, and mental health and his/her ability to live, work, study, and play with other like academic peers in a residential college environment. Circle “Yes” or “No” for each statement and provide information as requested. Yes No Has the student faced a significant event that continues to impact the student's daily life? If yes, please provide written information about the event – death of a loved one, divorce, new sibling, family change – its impact on the student's life, and important information for VSA staff as they work with your child: _________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Yes No During the past academic year, this student has seen or is currently seeing a professional to address mental/emotional/social concerns (If yes, specify the nature of the concern and other pertinent information for VSA staff to be aware of): __________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________ Yes No This student has a psychiatric diagnosis such as, but not limited to, depression, OCD, ODD, panic/anxiety disorder, ADHD, Autism Spectrum Disorder, bipolar, other. If yes, please specify and explain treatment: ______________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Yes No Yes No Are there any issues that that could potentially affect the students’ social or academic success while participating in VSA (e.g., learning disabilities, extreme shyness, acute homesickness). If yes, please explain and specify tips/interventions: _________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Are there any issues that could affect living at ease with a roommate? (Such issues could include, but are not limited to: sleep disorders, non-traditional gender identity, extreme sleep-walking, sleep-talking, bedwetting, chronic cough, excessive snoring, night terrors.) If yes, please explain the extent of the living arrangement concern and its potential impact on a roommate: _____________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Important: Legal Alert List all information, such as legal custody, restraining orders, or other legal agreements that impact the student's safety while attending VSA: Health History -9 of 17- VSA 2015 Welcome Documents PHYSICIAN’S STATEMENT OF GENERAL HEALTH Please have the student’s physician’s office complete this form, including the immunization record. Completed form should be returned to PTY with the student’s other Welcome Packet materials. Re: _______________________________________________________________ Student’s Name and Birth Date I understand that the above-named student has been accepted to attend the Vanderbilt Summer Academy (VSA), an intensive, summer residential program for academically talented youth during which participants attend classes, participate in sports and other recreational activities, and live in a residence hall with other students. To the best of my knowledge, this student has no chronic condition that would prohibit him or her from participating fully in VSA, and I have no reason to counsel otherwise. Physician’s Printed Name: _______________________________________________ Physician’s Signature: _____________________________ Date: _________________ Physician notes, if needed: ____________________________________________________________________________ ____________________________________________________________________________ Immunization Information Please complete all areas in the table below, recording the dates of immunizations or attaching the student’s immunization record. Vaccine Required: #1 (mo/yr) #2 (mo/yr) #3 (mo/yr) Varicella --2 shots or disease—check here □ Measles, mumps, rubella (2 shots) Meningococcal vaccine* (given at age 12 or older) Tdap booster (rising 7th and older) Hepatitis B (3 shots) Recommended (but not required): Vaccine #1 (mo/yr) Hepatitis A #2 (mo/yr) *The American Pediatrics Association recommends that all students age 12 and above received the Meningococcal vaccine. This is essential for residential living, but may be waived if the student is under 12 years of age. Physicians Statement -10 of 17- VSA 2015 Welcome Documents MENTAL HEALTH PROFESSIONAL’S STATEMENT OF GENERAL EMOTIONAL HEALTH Either sign the disclosure statement or ask the student’s mental health professional to complete this form. Completed form should be returned to PTY with the student’s other Welcome Packet materials. Re: _______________________________________________________________ Student’s Name and Birth Date This form is not pertinent to my child’s situation, as indicated on the Student Health Disclosure form. My child has no concerning social, emotional, or behavioral issues that necessitate involving a mental health professional statement. Parent/Legal Guardian’s Signature and Date OR For Mental Health Professional: I understand that the above-named student has been accepted to attend the Vanderbilt Summer Academy (VSA), an intensive, summer residential program for academically talented youth during which participants attend classes, attend social events, participate in sports and other recreational activities, and live in a residence hall with other students for one to three weeks. By signing, I attest that to the best of my knowledge, this student has no condition that would prohibit him or her from participating fully in VSA unless indicated below, and I have no reason to counsel otherwise. Mental Health Professional’s Printed Name: ______________________________________________ Mental Health Professional’s Signature: ___________________________________________________ (Date) Please provide a brief explanation of your professional opinion regarding the student’s capability to succeed at VSA. Include any reservations or recommendations you may have to ensure the student has a positive experience as well as other information helpful for our staff to know while working with this child. Mental Health -11 of 17- VSA 2015 Welcome Documents STUDENT & PARENT AGREEMENT OF POLICIES I have read the Vanderbilt Summer Academy Student Handbook (enclosed in this packet or located at pty.vanderbilt.edu/students/vsa/admitted) in its entirety and agree to abide by the policies and procedures stated therein. Student’s Printed Name: _______________________________________________________ Student’s Signature: ____________________________________________ Date: _________ Parent/Legal Guardian’s Printed Name: ___________________________________________ Parent/Legal Guardian’s Signature: ________________________________ Date: _________ **The policies outlined in this document apply from the date signed to 9/3/2015. Agreement of Policies -12 of 17- VSA 2015 Welcome Documents MEDIA & DATA RELEASE Student Name: ____________________________________________ This release is a standard media release required by Vanderbilt University (hereinafter VU) for any person participating in an on-campus program or activity where university staff or designees may take photos and/or record video of the participants. VSA staff often take photos of students, faculty, proctors and other staff throughout each session for use in the end-of-session slideshow. Such photos may also be used in future Programs for Talented Youth (hereinafter PTY) catalogs, on our website or in other media as outlined below. By signing this release, you agree to allow your student to appear in such photos as well as in any class, activity and session photos. * • I authorize VU faculty, staff, the VU Media and Public Relations staff, other VU personnel and third party entities such as newspapers and television stations to make photographs or videos of me and or my child to exhibit, publish, televise, or otherwise show said photographs or videos for educational and related purposes and to permit others to do the same. I understand that there is a possibility that I (or my child) may be identifiable in these photographs or videos, though my name or my child’s name will not be published. • I further authorize members of the VU Media and Public Relations staff and other VU personnel, to make and publish photographs, videos, or written/audio accounts of me (or my child) in newspapers, magazines, other publications, television, motion pictures, Internet, or other media, which will be circulated to the general public for marketing, business, or any other purpose, or to provide access to members of the public media to do the same. I understand that there is a possibility that I (or my child) may be identifiable in these photographs, videos, or written/audio accounts. Often media outlets require that filmed participants names be published. I give permission for my name or my child’s name to be given to the media. • I release any and all rights or claims for payment or royalties in connection with any exhibition, televising, or other showing of these motion pictures, videotapes, or photographs, regardless of whether such exhibition, televising, or other showing is under philanthropic, commercial, or private sponsorship, and regardless of whether a fee of admission or film rental is charged. • I further agree to allow VU to collect and evaluate student data such as surveys, opinions, and coursework for research/evaluative purposes. This information may be published. Students will not be identified by name and such data will be used to further understanding of teaching, learning, and gifted education. • I understand that I may refuse to sign this authorization, and that my refusal to sign will not affect my (or my child’s) ability to participate in this activity. I understand that this authorization may be revoked in writing at any time, except to the extent that action has been taken in reliance of this authorization. • I understand that the information released may be subject to re-disclosure by some recipients and may no longer be protected by federal and state privacy rules related to health or other information. • I understand that VU cannot protect me/my child from being photographed, videoed or potentially identified or named on social media sites, by others including students or their families. • I understand that authorization for use at individual’s request will not expire. • I agree to release, hold harmless and indemnify Vanderbilt University and its representatives against loss from any and all claims of ordinary negligence, demands, rights, or causes of action of any kind that may at any time hereafter be made or brought by my child, by me or anyone on my behalf, or by any other person having a legal interest therein arising from or by reason of any and all known or unknown, foreseen and unforeseen uses. READ BEFORE SIGNING: By signing below, I acknowledge that I am 18 years of age or older. I have read the foregoing Release in its entirety and understand that I am signing a complete and perpetual release and bar to any and all claims as defined by the listed agreements. If the participant is not 18 years of age or older, this release must be signed by a parent or legal guardian. Parent/Legal Guardian’s Signature ___________________________________________Date: ___________ Printed Parent/Legal Guardian’s Name _______________________________________ *Please note that if this form is not signed, your student cannot appear in any photo taken by our staff, nor will we be able to post any photos of your student to our Facebook or Twitter pages. Our policy is to obscure identifying information (such as a name tag) in every student photo. **The policies outlined in this document apply from the date signed to 9/3/2015. Media & Data -13 of 17- VSA 2015 Welcome Documents TRANSPORTATION INFORMATION See “Traveling to Vanderbilt” chapter of Student Handbook for more information on traveling to/from VSA. Student Name: ___________________________________________________ Contact phone numbers on travel days: Parent/Legal Guardian Cell Phone: ________________________________________ Student Cell Phone: ____________________________________________________ Airport Pickup: For students traveling alone to Nashville by air, VSA provides airport pick-up/drop-off on arrival and departure days for $25 each way; $50 round trip (attach check for applicable amount to this form). Note that this service is available ONLY to students who are flying alone. Arrival Information: How is the student arriving at VSA on opening day? Please note, check-in begins at 3:00 pm local time. Check applicable option below. Student will be dropped off at campus by parent/guardian. Student is flying alone and will need transportation from the airport to campus. Please be advised that Delta security policies regarding unaccompanied minors may well result in additional wait times for your student. Please call our office at 615-322-8261 if you have any questions. Our first pickup at the airport will be at 12pm on check-in day. Please schedule a flight that arrives in Nashville between 11:00am-4pm. Note that students will not receive the keys to their rooms until official check-in begins at 3pm. Due to VSA program commencement student arrivals after 4:00 pm local time are strongly discouraged. Airline___________________________________________ Flight #_______________________ Arrival Time at BNA: ______________________________ Confirmation #____________________ Does the airline classify your student as an "Unaccompanied Minor"? Y N We will send air travelers an email approximately one week prior to opening day with information on what to do upon arrival at the Nashville airport as well names/contact information of VSA staff members who will meet you at the airport. Transportation -14 of 17- VSA 2015 Welcome Documents Departure Information: How is student departing from VSA on closing day? Please note: the dormitory closes at 3:00 pm local time for Session I and 12:00 pm local time for Sessions II & III. Check applicable option below. Student will be picked up at campus by parent/guardian. Student is flying alone and will need from campus to the airport. Please be advised that Delta security policies regarding unaccompanied minors may result in additional wait times for your student. Please call our office at 615-322-8261 if you have any questions. Student is flying alone out of Nashville and will require transportation to BNA on check out day. Please schedule your student’s departing flights as follows: For Sessions 2 II & 3III: 8am-1pm* For Session 1I: 1pm-4pm*. Note that we can accommodate earlier departure times the day of check out if necessary. Airline ______________________________________________ Flight # ____________________________ Departure Time from BNA: ______________________________ Conf. # ___________________________ Does the airline classify your student as an "Unaccompanied Minor"? Y N . * A note on “Unaccompanied Minor” status: Airlines have varying policies and age-limits on this. Check with your airline to determine whether or not they will require “UM” status for your student. Fees and restrictions often apply and could cause delays at travel times if a required fee is unpaid. These fees are the responsibility of families. UM travelers should schedule their departing flight from Nashville as early in our check-out window as possible. According to airline policies UM travelers SHOULD NOT book a final flight of the day under any circumstances. Authorized Pickup Information Please list all the individuals who are allowed to pick up your student. We assume primary/secondary and emergency contacts listed are able to pick up the student. For all others include name, phone number, and relationship to you/the student. Individuals picking up students should be prepared to show photo ID. Name: __________________________ Relationship: _______________ Phone: ____________ Name: __________________________ Relationship: _______________ Phone: ____________ Name: __________________________ Relationship: _______________ Phone: ____________ Transportation -15 of 17- VSA 2015 Welcome Documents ARETÉ OPTIONS & SELECTIONS Please place a check mark (✓) by at least 5-6 Areté classes that interest you and return this sheet with your other VSA documents. While making your selections, do not rank-order them. We cannot guarantee Areté placements as the Areté offerings are subject to change from week to week. You will learn your Areté placements during your first Proctor Group Meeting on opening night. Remember, Areté classes are an opportunity for you to explore something new and different. No previous experience is necessary in any of these classes. So be open-minded and completely fearless. Areté is a safe way to try something new, and if you’re really bold and daring, select “Surprise Me!!” and wait to see what fun will happen! _____GRAVITY-ONLY BOOT-CAMP This boot camp-style fitness training will use only your body-weight and Mother Earth to improve cardio, strength, balance and overall health. If you want to spend this hour raising your heart rate and breaking a sweat, this is the Areté for you. _____FENCING En Garde! In this introductory fencing workshop, you’ll learn basic footwork, parry and use of foils. Fencing teaches hand-eye coordination and strategic thinking. Plus, you’ll get to brandish a sword (safely, of course)! All equipment and safety gear will be provided. Instructor is an experienced fencer who will instruct students in proper safety & technique. _____THE ART OF THE HENNA TATTOO No needles. It’s not permanent. Yet it’s a beautiful art form. Learn how to design and apply henna body art to hands and arms as well as the stories behind its symbolic and ceremonial uses in cultures around the world. _____MARTIAL ARTS & SELF DEFENSE The odds are that you’ll never be attacked or mugged. Still, wouldn’t it be nice to know what to do if you were? This class will teach students basic techniques drawn from different martial arts to learn effective methods of self-defense. You’ll learn creative ways to disable an opponent no matter your height or body strength. _____YOGA Meaning “to unite,” yoga promotes balance of the body and mind through a series of postures and mindful breathing. Although yoga has become a fashionable form of exercise, it actually derives from an ancient Indian spiritual tradition that is more than 5000 years old. You’ll understand yoga’s enduring presence as you leave this class centered, calm, and energized. _____SPOKEN WORD Explore poetry on the page and then take it to the stage. Craft and perform original pieces in several styles of spoken word performance, engaging with the power of rhythm and language. Find your voice and let it fly. _____STAGE COMBAT Always wanted to know how onstage and on screen fights look so real? Learn the basics of executing safe and realistic unarmed stage combat. This workshop is led by a trained actor/combatant who is a member of the Society of American Fight Directors (SAFD) and will culminate in a short stage combat sequence. ____SONGWRITING Nashville is Music City! What better place to try your hand at writing and maybe even preforming an original piece of music. Work with an experienced songwriter to give life to your inner melodies. _____JUGGLING Even if you are all thumbs, by the end of the week you will impress others with your agility. Not only is this class great fun, it teaches you how to multi-task and to keep your eye on the ball. Once you start, you won’t be able to stop. _____CARTOONING AND CARICATURE Animate and exaggerate. Showcase your wit and humor with pen and paper, possibly even add a touch of satire. You’ll have a chance to create stand-alone images, to learn the basics of cartooning, and to amuse your friends with your visual sense of humor. _____SLEIGHT-OF-HAND MAGIC Learn sneaky card tricks and other sleight-of-hand illusions to confound your family and friends. You’ll also get to practice how to keep your audience enthralled through your amazing tricks and your witty magician’s banter. _____FLASH MOB This interactive performance experience will allow you to combine many of your existing skills and develop some new ones along the way. Choreography, dancing, and surprise are all incorporated into this public, musical experience. _____IMPROV Jump into the fundamentals of improvisation and performance. Participants will learn to perform spontaneous comedic scenes based on just a few prompts and cues. Improv also teaches valuable life skills such as listening, communication, self-confidence and creativity through theatre games and exercises. _____STEP Learn an amazing step routine in just four days! Using rhythmic steps, stomps and handclaps, we’ll create an energetic performance piece to rival some of the premier step-teams in the country! Stepup! _____PITCH PERFECT A cappella singing is more popular than ever at VU, from the Swingin’ Dores to the Melladores. Learn to turn a popular song into an original a cappella performance including sound effects and percussion using only the human voice! Trained singing voice not required. Just bring a desire to vocalize and harmonize! _____SURPRISE ME!! I’LL TRY ANY! Areté -16 of 17- VSA 2015 Welcome Documents STUDENT PHOTO Please attach a recent photo of your student to the space below. Photos are a great help to us at VSA, as we get to know many students in a short period of time. Photos will remain with student paperwork and are only used for the purpose expressed above. Any photo is fine, as long as it clearly captures your student in a natural, recognizable manner. Re: _______________________________________________________________ Student’s Name and Birth Date Photo: Student Photo -17 of 17-