Overview of Away Regattas 2018

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1 Overview of Away Regattas 2018 There are 3 away regattas planned for spring 2018 requiring the effort and coordination of the entire team. Saturday, April 7th St. Andrew s Invitational: Middletown, DE - All rowers participate and chaperones will be necessary. Rowers will carpool with parents to Middletown, DE. All spectators welcomed and there is no additional fee to participate. Thursday, May 17th through Saturday, May 19th Stotesbury Cup Regatta: Philadelphia, PA - Select boats/rowers participate and chaperones will be necessary. Rowers will be transported by chartered bus and carpools. Additional fee for rowers and chaperones will be assessed (approximately $400/each) for hotel, security, transportation, food, etc. Additional spectators encouraged. Thursday, May 24th Saturday, May 27th SRAA Nationals: Camden, NJ - Select boats/rowers participate and chaperones will be necessary. Rowers will be transported by chartered bus and/or carpools. Additional fee for rowers and chaperones will be assessed (approximately $350/each) for hotel, transportation, security, food etc. Additional spectators encouraged. Preparation for these Away Regattas is an enormous effort. Therefore, ALL CREW MEMBERS MUST COMPLETE THE FOLLOWING PACK OF FORMS by the mandatory Kick Off and Safety Meeting on February 15, Forms can also be scanned and ed to Claire.marble@conferencedirect.com or dropped off at the home of Claire Marble at 405 Blair Rd NW Vienna, VA All rowers must complete forms for ALL REGATTAS, even though boat and rower determinations for Stotesbury and SRAA Nationals won t be made until April/May. Any questions, please Claire Marble at Claire.marble@conferencedirect.com

2 AWAY REGATTA COVER SHEET INFORMATION AND FORM CHECKLIST (Return this with your forms please) Rower Name (Last, First) Parent(s)/Guardian(s) 1) Are you willing to consider being a chaperone? St. Andrew's Invitational 4/7 (Yes/ No) Stotesbury Cup Regatta 5/17-5/19 (Yes/No) SRAA Nationals 5/24-5/26 (Yes/ No) 2) Are you willing to drive? St. Andrew's Invitational 4/7 (Yes/No) Stotesbury Cup Regatta 5/17-5/19 (Yes/No) SRAA National s 5/24-5/26 (Yes/No) 3) Can you help with luggage check? St. Andrew's Invitational 4/1 (Yes/No) Stotesbury Cup Regatta 5/17 (Yes/No) SRAA National s 5/24-5/26 (Yes/No) Submitted? (a) Verified (leave blank) Form Summary Notes for Chaperones and Hospitality Volunteers Parental Authorization and Acknowledgement of Risk for Field Trip St. Andrews Stotesbury SRAA Nationals Field Trip Luggage Search St. Andrews Stotesbury SRAA Nationals Trip Medication Authorization to Bring and Self Administer Medicines St. Andrews Stotesbury SRAA Nationals Field Trip Driver s License and Vehicle Insurance Information St. Andrews Stotesbury SRAA Nationals Emergency Care Information Medication Authorization Required? Required Required Required Required Required Required Required If applicable If applicable If applicable If willing to drive If willing to drive If willing to drive Required ONLY if info changed since submitted with registration (e.g., insurance, meds, etc.) Required ONLY if you prefer to have FCPS employee handle medications

3 Away Regattas Summary Notes for Chaperones and Hospitality Volunteers The health and safety of each rower is our highest priority and our coaches are responsible for the Emergency Care Forms submitted with registration, but our chaperones and hospitality volunteers would like to have some information to better prepare for away regattas. Please fill out the following information: Rower s Name (Last, First) Rower Cell phone during away regattas Emergency Contact during away regattas Phone number(s) for Emergency Contact Rower dietary restrictions (If due to a food allergy, please note after each restriction "A (M)" for mild allergy or "A(S)" for severe allergy, note vegetarian/vegan/gluten-free/etc. if applicable. Each chaperone will be equipped with a basic first aid kit and limited over the counter medications. Please note (Yes/No) if your child may receive Pepto Bismol/Tums/Rolaids, Imodium, Tylenol Advil, Dramamine, Benadryl, Cough drops If your child brings medication of the trip, we must have a list of all medications (prescription and over the counter) and both rower and parent must authorize the rower to carry his/her own medication or release and indemnify FCPS employees authorized to carry the medications on his/her behalf. (See separate documentation of this authorization or indemnification) Please list medications (prescription and over the counter) that your rower intends to bring on the away regattas: Please note if you intend to allow your child to carry his/her own medications (Yes/No) Parent/Guardian Signature and :

10 TRIP MEDICATIONS AUTHORIZATION TO BRING and SELF- ADMINISTER MEDICINES If applicable, please complete and submit this form AND PUT A COPY OF THIS FORM IN YOUR SUITCASE/BACKPACK IN A ZIPLOC BAG WITH ANY AND ALL MEDICATION BROUGHT BY A STUDENT TO AN AWAY REGATTA TO BE REVIEWED DURING LUGGAGE SEARCH This form is necessary for ALL medications both prescription and nonprescription. It must be signed by the rower AND a parent/guardian My student has my permission to bring and self-administer the following medications while on the away regatta to _St. Andrews Invitational Rower s Name (Last, First) Medications and planned dosages and frequency of dosages Parent/Guardian Signature and I, (student s name) will follow all medication instructions and will not dispense any medication to anyone other than myself. Failure to comply by the rules will result in my dismissal from the regatta and possible suspensions/expulsion by FCPS upon my return. Student Signature and :

11 TRIP MEDICATIONS AUTHORIZATION TO BRING and SELF- ADMINISTER MEDICINES If applicable, please complete and submit this form AND PUT A COPY OF THIS FORM IN YOUR SUITCASE/BACKPACK IN A ZIPLOC BAG WITH ANY AND ALL MEDICATION BROUGHT BY A STUDENT TO AN AWAY REGATTA TO BE REVIEWED DURING LUGGAGE SEARCH This form is necessary for ALL medications both prescription and nonprescription. It must be signed by the rower AND a parent/guardian My student has my permission to bring and self-administer the following medications while on the away regatta to _Stotesbury Regatta, Philadelphia, PA Rower s Name (Last, First) Medications and planned dosages and frequency of dosages Parent/Guardian Signature and I, (student s name) will follow all medication instructions and will not dispense any medication to anyone other than myself. Failure to comply by the rules will result in my dismissal from the regatta and possible suspensions/expulsion by FCPS upon my return. Student Signature and :

TRIP MEDICATIONS AUTHORIZATION TO BRING and SELF- ADMINISTER MEDICINES If applicable, please complete and submit this form AND PUT A COPY OF THIS FORM IN YOUR SUITCASE/BACKPACK IN A ZIPLOC BAG WITH

12 TRIP MEDICATIONS AUTHORIZATION TO BRING and SELF- ADMINISTER MEDICINES If applicable, please complete and submit this form AND PUT A COPY OF THIS FORM IN YOUR SUITCASE/BACKPACK IN A ZIPLOC BAG WITH ANY AND ALL MEDICATION BROUGHT BY A STUDENT TO AN AWAY REGATTA TO BE REVIEWED DURING LUGGAGE SEARCH This form is necessary for ALL medications both prescription and nonprescription. It must be signed by the rower AND a parent/guardian My student has my permission to bring and self-administer the following medications while on the away regatta to _SRAA Nationals, Camden, NJ Rower s Name (Last, First) Medications and planned dosages and frequency of dosages Parent/Guardian Signature and I, (student s name) will follow all medication instructions and will not dispense any medication to anyone other than myself. Failure to comply by the rules will result in my dismissal from the regatta and possible suspensions/expulsion by FCPS upon my return. Student Signature and :

13 FIELD TRIP DRIVER'S LICENSE AND VEHICLE INSURANCE INFORMATION (required when transporting students on field trips in personal or leased vehicles) Information on the driver and the driver's liability insurance is required for all personal and leased vehicles used to transport students (not applicable for school bus or commercial bus drivers or vehicles). FIELD TRIP PLAN (to be completed by the teacher) Specific Trip Repeated Trip April 7, 2018 Explain Destination St. Andrews School, Middletown, DE Purpose Participate in the St. Andrews Invitational Regatta PART I. DRIVER Name DRIVER AND INSURANCE INFORMATION (to be completed by the driver and the owner or lessee of vehicle) Student Parent Teacher or Staff Member Other Operator's License Number State Expiration I certify that the vehicle I will use for this field trip: is designed and manufactured to transport fewer than ten passengers meets Federal Motor Vehicle Safety Standards and state standards applicable to passenger car occupant protection standards (at the time the vehicle was manufactured) has a certified seat and seat belt for each passenger (owner- or dealer-installed seats and/or seat belts are not certified) Driver's Signature PART II. INSURANCE Owner or Lessee of Insured Vehicle Insurer SCHOOL PRINCIPAL APPROVAL Principal's Signature FS-142 (9/10)

14 FIELD TRIP DRIVER'S LICENSE AND VEHICLE INSURANCE INFORMATION (required when transporting students on field trips in personal or leased vehicles) Information on the driver and the driver's liability insurance is required for all personal and leased vehicles used to transport students (not applicable for school bus or commercial bus drivers or vehicles). Vehicle Make FIELD TRIP PLAN Model Owner's or Lessee's Signature (to be completed by the teacher) Specific Trip Repeated Trip 05/17-19/2018 Explain Destination Philadelphia, PA Purpose Attend and Participate in Stotesbury Regatta DRIVER AND INSURANCE INFORMATION (to be completed by the driver and the owner or lessee of vehicle) PART I. DRIVER Name Student Parent Teacher or Staff Member Other Operator's License Number State Expiration I certify that the vehicle I will use for this field trip: is designed and manufactured to transport fewer than ten passengers meets Federal Motor Vehicle Safety Standards and state standards applicable to passenger car occupant protection standards (at the time the vehicle was manufactured) has a certified seat and seat belt for each passenger (owner- or dealer-installed seats and/or seat belts are not certified) Driver's Signature SCHOOL PRINCIPAL APPROVAL Principal's Signature FS-142 (9/10)

15 FIELD TRIP DRIVER'S LICENSE AND VEHICLE INSURANCE INFORMATION (required when transporting students on field trips in personal or leased vehicles) Information on the driver and the driver's liability insurance is required for all personal and leased vehicles used to transport students (not applicable for school bus or commercial bus drivers or vehicles). PART II. INSURANCE Owner or Lessee of Insured Vehicle Insurer FIELD TRIP PLAN Vehicle Make Model Owner's or Lessee's Signature (to be completed by the teacher) Specific Trip Repeated Trip 05/24-26/2018 Explain Destination Cherry Hill, PA / Camden, NJ Purpose Attend and Participate in SRAA National Championship Regatta PART I. DRIVER Name DRIVER AND INSURANCE INFORMATION (to be completed by the driver and the owner or lessee of vehicle) Student Parent Teacher or Staff Member Other SCHOOL PRINCIPAL APPROVAL Principal's Signature FS-142 (9/10)

16 FIELD TRIP DRIVER'S LICENSE AND VEHICLE INSURANCE INFORMATION (required when transporting students on field trips in personal or leased vehicles) Information on the driver and the driver's liability insurance is required for all personal and leased vehicles used to transport students (not applicable for school bus or commercial bus drivers or vehicles). FIELD TRIP PLAN Operator's License Number State Expiration I certify that the vehicle I will use for this field trip: is designed and manufactured to transport fewer than ten passengers meets Federal Motor Vehicle Safety Standards and state standards applicable to passenger car occupant protection standards (at the time the vehicle was manufactured) has a certified seat and seat belt for each passenger (owner- or dealer-installed seats and/or seat belts are not certified) Driver's Signature PART II. INSURANCE Owner or Lessee of Insured Vehicle Insurer Vehicle Make Model Owner's or Lessee's Signature Principal's Signature FS-142 (9/10)

17 COMPLETE ONLY IF INFORMATION HAS CHANGED SINCE SUBMISSION OF INFORMATION TO COACHES WITH REGISTRATION EMERGENCY CARE INFORMATION In case of an emergency, the school staff will contact 911. will be made to contact a parent, a guardian, or a designated emergency contact STUDENT INFORMATION Every attempt Last: First: Middle: of Birth: Gender: Grade: M F School Name: ID No.: Teacher or Counselor : Bus # (AM): Bus # (PM): Student has medical alert information on file. See page 2 for details. PARENT/GUARDIAN CONTACT INFORMATION This form is to be completed by the enrolling parent. The enrolling parent is the natural or adoptive parent or legal guardian with whom the student lives the preponderance of the school week and who enrolled the student in school. Enrolling Parent Last: First: Middle: Telephone Home: Number: Street: Apt.#: City: State: Zip: Work: Relati onshi p: Foster Parent Mother Father Legal Guardian Self Resides with Language: Other Parent Last: First: Middl e: Telephone Cell: Number: Street: Apt.#: Home: City: State: Zip: Work: Cell: Relationship: Resides with Language: Other Parent Last: First: Middl e: Telephone Number: Street: Apt.#: Home: City: State: Zip: Work: Cell: Relationship: Language: Resides with

18 Other Parent Last: First: Middl e: Telephone Number: Street: Apt.#: Home: City: State: Zip: Work: Cell: Relationship: Resides with Language: OTHER CONTACT INFORMATION Please list at least two people we may call if the parent(s) or guardian(s) cannot be reached in the event of an emergency. These people also have your permission to pick your child up from school during the school day. Name of Person Relationship Language Telephone * Please remember to sign page 2. Page 1. EMERGENCY CARE INFORMATION In case of an emergency, the school staff will contact 911. Every attempt will be made to contact a parent, a guardian, or a designated emergency contact. STUDENT INFORMATION Last: First: Middle: of Birth: Gender: Grade: M F School Name: ID No.: Teacher or Counselor: Bus # (AM): Bus # (PM): Siblings attending the same school (complete if applicable). Name(s): Is Internet access available in your home for your child/children? Yes No Declined

MEDICAL ALERT INFORMATION ON FILE This space reserved for system printing of Health Information PHYSICIAN INFORMATION My child's medical care is provided by: ( name of doctor, clinic, or HMO) (

19 MEDICAL ALERT INFORMATION ON FILE This space reserved for system printing of Health Information PHYSICIAN INFORMATION My child's medical care is provided by: ( name of doctor, clinic, or HMO) ( telephone ) Does your child have health insurance? Yes No If yes, medical coverage is provided by: ( health insurance company, assistance program, HMO, etc.) ( telephone ) First aid and emergency treatment will be provided to students in accordance with the current version of FCPS Regulation 2102 or in accordance with the student's individualized health plan. ENROLLING PARENT OR GUARDIAN SIGNATURE: DATE: SS/SE-3 (4/14) Page 2 Click here to reset the student specific fields on this form. Parent or Guardian information will not be affected by this RESET function.

PLEASE READ INFORMATION AND PROCEDURES ON REVERSE SIDE PART I PARENT OR GUARDIAN TO COMPLETE MEDICATION AUTHORIZATION **AS NEEDED** Release and Indemnification Agreement I hereby request Fairfax

20 PLEASE READ INFORMATION AND PROCEDURES ON REVERSE SIDE PART I PARENT OR GUARDIAN TO COMPLETE MEDICATION AUTHORIZATION **AS NEEDED** Release and Indemnification Agreement I hereby request Fairfax County Public Schools (FCPS), Fairfax County Health Department (FCHD), and School Age Child Care (SACC) personnel to administer medication as directed by this authorization. I agree to release, indemnify, and hold harmless FCPS, FCHD, SACC, and any of their officers, staff members, or agents from lawsuits, claims, expenses, demands, or actions, etc., against them for helping this student use medication, provided FCPS, FCHD, and SACC staff members comply with the physician, parent or guardian orders set forth in accordance with the provision of part II below. I have read the procedures outlined on the back of this form and assume responsibility as required. Has the student taken Yes No (If no, the first full dose must be given at home to ensure that the student does not have a negative reaction.) this medication before? Student Name (Last, First, Middle) First dose was given: Time of Birth School Name School Year Grade No School Board employee, public health nurse, or school health aide shall administer medication or treatment, as an exception under School Board policy, unless the principal or his or her designee has personally reviewed all the required clearances. Parent or Guardian Signature Daytime Telephone PART II PARENT OR GUARDIAN TO COMPLETE AND SIGN FOR OVER-THE-COUNTER MEDICATION FOR RELIEF OF SYMPTOMS FOR HEADACHE, MUSCLE ACHE, ORTHODONTIC PAIN, OR MENSTRUAL CRAMPS AND FOR ANTIBIOTIC AND ANTIVIRAL MEDICATION. PHYSICIAN MUST COMPLETE AND SIGN FOR ALL OTHER MEDICATIONS. The Fairfax County Health Department and Fairfax County Public Schools discourage the use of medication by students in school during the school day. Any necessary medication that possibly can be taken before or after school should be so prescribed. Injectable medications are not administered in schools except in specific emergency situations. School personnel will, when it is absolutely necessary, administer medication during the school day and while participating in outdoor education programs and overnight field trips and school crisis situations according to the procedures outlined on the back of the form. Information should be written in lay language with no abbreviations. Diagnosis Medications If medication is given on an as-needed basis, specify the symptoms or conditions when medication is to be taken and the time at which it may be given again. Dosage to be given at school or SACC, (e.g. mg, ml, or cc) Effective date Current School Year From To Time(s) or interval between times to be given If the student is taking more than one medication at school, list sequence in which medications are to be taken Physician Name (Print or Type) Physician Signature Telephone or Fax Parent or Guardian Name (Print or Type) Parent or Guardian Signature Telephone (Not required if physician signs) PART III PRINCIPAL OR PRINCIPAL DESIGNEE TO COMPLETE Check as appropriate Parts I and II above are complete including signatures. (It is acceptable if all items in part II are written on the physician's stationery or a prescription pad.) Medication is appropriately labeled. by which any unused medication is to be collected by the parent. (Within one week after expiration of the physician order or on the last day of school.) Principal or Designee Signature

21 Information from the Fairfax County Public Schools student scholastic record is released on the condition that the recipient agrees not to permit any other party to have access to such information without the written consent of the parent, guardian, or eligible student. SS/SE-63 7/13 Distribution: Original-School, Copy-Parent or Guardian

CHAMPS REGISTRATION Continued Hours at Mansfield Public Schools 255 East Street, Mansfield, MA ~

CHAMPS REGISTRATION Continued Hours at Mansfield Public Schools 255 East Street, Mansfield, MA ~ CHAMPS 2015-2016 REGISTRATION Continued Hours at Mansfield Public Schools 255 East Street, Mansfield, MA 02048 ~ 508-261-7539 Welcome to CHAMPS for the 2015-2016 school year. Registration is now open for