Operation Snowball 2015 Registration Form

* Please complete reverse side.
Medical/Liability Release
My son/daughter has my permission to attend the
Operation Snowball Event, which will be held on
Saturday, April 18, 2015, and to participate in all
phases of the activities. He/she is in good physical
condition at this present time and has no serious
illness. He/she is not currently on any medications
except as listed below. I designate all discipline and
emergency decisions to the Operation Snowball staff
and hereby release the sponsors and staff from any
liability. I understand that the staff of the Operation
Snowball Event is not responsible in the event of an
accidental injury or illness.
If your son/daughter takes prescription medication,
he/she will be expected to turn in all non-prescription
and prescription medication upon arrival to the nurse
and will be returned at the end of the retreat.
Medications and times to be administered
_____________________________________
______________________________________
______________________________________
______________________________________
Allergies, Dietary Considerations, or
Medical Concerns
______________________________________
______________________________________
______________________________________
PARENT/GUARDIAN SIGNATURE DATE
PARENT EMAIL:
__________________________________
EMERGENCY NUMBER:
__________________________________
Please indicate if you would like to attend our
free parent breakfast at 7:30am, with parent
presentation by Javier Sanchez to follow from
7:45 – 8:30am.
Yes
No
* Please complete reverse side.
OS 2015 Special
Presentations by
Javier Sanchez
Since 1992, Javier has been inspiring and
equipping youth and adults to be
intentional about adding process to their
passion. Javier believes that once you
have a vision and a sense of purpose for
your life there are almost NO LIMITS to
what you can accomplish. As an author,
performer, and filmmaker, Javier has the
opportunity to deliver life building
messages to youth and adults all over the
planet while keeping them entertained
through comedy, spoken word poetry, and
powerful stories from his own life.
Javier’s experience and expertise in
effective student and community
engagement / empowerment comes from
more than 10 years of work with the
Youth to Youth International Program
both in the United States and abroad as a
Youth Program Coordinator. In 2003 he
was awarded the Robert Wood Johnson
Foundation’s Developing Leaders in
Reducing Substance Abuse Fellowship
and is a graduate of the Ray Miller
Institute for Change and Leadership.
Operation Snowball
2015
D211 SouthSide
Snowball
Conant, Hoffman Estates, and
Schaumburg High Schools
Saturday, April 18,
2015
Time: 7:00 AM–
11:00 PM
Location: James B. Conant
High School
700 E. Cougar Trail, Hoffman
Estates, IL 60169
Operation Snowball
Operation Snowball is founded on the belief that,
through adequate information and self-understanding,
every person has the capacity to make sound
decisions and positively influence others.
Operation Snowball takes its name from the idea that
positive thinking can spread from person to person,
growing as a snowball grows.
The Operation Snowball event is a daylong
experience designed by teens, for teens. The
program uses presentations, workshops, activities, and
small group discussions to assist teens in
learning to make healthy choices, enhance their
self-esteem, and confidence.
Emphasis is on developing and refining responsible
decision making skills and creating a positive impact
on their peers. Participants can expect to meet new
people, as well as practice communication and
leadership skills. The Snowball philosophy allows
teens to make a positive impact on their peers at
school and in their community.
To learn more about the history of Operation
Snowball, please visit www.os-iti.org.
Expectations
Participants are expected to stay for the
entire event and participate in all scheduled
Snowball activities.
The use of alcohol, tobacco, or other drugs at this
event is strictly prohibited.
All non-prescription and prescription
medication must be turned in to the nurse upon
arrival and will be returned at the end of the
retreat.
Operation Snowball will not be responsible for
personal items that are lost or stolen.
Participants will notify Snowball staff
immediately in the event of illness or
injury.
Participants will follow the Code of
Behavior for school events as outlined in their
handbook.
What to bring to Snowball:
Wear comfortable clothes.
An open mind.
What to leave behind:
Portable electronics, PHONES (if a phone is brought,
it will be collected and returned at end of day),
and other valuables
Alcohol, tobacco, and other drugs
OPERATION
SNOWBALL 2015
Cost to Attend
A payment of $25 is due by
April 4, 2015
Space is limited to 300
participants.
Register early!!
The fee includes breakfast, lunch,
dinner, t-shirt, and materials for the
day. Make checks payable to
Hoffman Estates High School.
There are full and partial
need-based scholarships
available for those who qualify.
Please contact
Mrs. Cordova for more details.
* Please complete reverse side.
April 18, 2015 7:00 AM - 11:00PM PM
PARTICIPANT NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
HOME PHONE #
EMERGENCY #
AGE
YEAR
GENDER
Please circle one:
T-Shirt Size: S
M
L
ID #
XL XXL
Please check here if you will need vegetarian meals____
Refund Policy: Full refunds until
April 4, partial refunds from April 4
to April 17, no refunds on day of
event.
Once all sides of this application are
completed, please return the entire
form, along with payment, to your
school’s cashier. CASH OR CHECKS
ARE ACCEPTED
I give permission for my son/daughter:
PRINT NAME OF PARTICIPANT
to attend the Operation Snowball event. I understand that my
child must stay for the entire day from 7:00 AM - 11:00 PM
on April 18, 2015.
I also acknowledge, understand, and agree that I have read
the Operation Snowball expectations and will abide by them
during Operation Snowball.
PARENT SIGNATURE
DATE
PARTICIPANT SIGNATURE
DATE
STUDENT EMAIL: ____________________________
* Please complete reverse side.