GRIMSLEY HIGH SCHOOL BAND 2018 SPRING TRIP ORLANDO, FLORIDA UNIVERSAL STUDIOS, UNIVERSAL S ISLANDS OF ADVENTURE AND SEAWORLD MARCH 15, 2018 MARCH

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1 This band trip pricing is based on taking one 56 passenger bus. We will accept the first 52 students who turn in the trip paperwork and pay the $200 deposit. When the bus is full, we will start a waiting list of students who have turned in the trip paperwork and paid the $200 deposit. If students drop out, we will accept students on the waiting list. If a space does not open up for students on the waiting list, we will refund the $200 deposit. When we receive your trip paperwork and $200 deposit, we will send you an confirmation. If you do not receive the confirmation, contact us to confirm that your paperwork is not lost in the mail. You will also know that we have received your paperwork when you see your $200 deposit check clear your bank account. Dr Stuber will have a list of students who have turned in the trip paperwork and paid the $200 deposit. Students can check with Dr Stuber to confirm that we have their trip paperwork and $200 deposit.

2 The trip will cost $800 per student and will include the following: Transportation to and from Orlando, Florida via deluxe video-equipped motor coach Two nights accommodations (4 students per room) and two breakfasts at the hotel Two day Universal Studios/Universal s Islands of Adventure Park Hopper Pass with two meal vouchers for lunch One day SeaWorld Pass with meal voucher for lunch Marching band and jazz band performances at Universal Studios/Universal s Islands of Adventure Blue Man Group Show One adult chaperone (2 adults per room) for every ten students PRELIMINARY ITINERARY (subject to change): Thursday, March 15, :00 pm Depart from Grimsley High School for Orlando, Florida Friday, March 16, :00 am Arrive in Orlando, Florida Universal Studios/Universal s Islands of Adventure Saturday, March 17, 2018 Universal Studios/Universal s Islands of Adventure Marching Band Performance Jazz Band Performance Blue Man Group Show Sunday, March 18, 2018 SeaWorld 10:00 pm Board buses and depart for Greensboro Monday, March 19, :00 am Arrive at Grimsley High School Students will miss two days of school (Friday, March 16, 2018 and Monday, March 19, 2018). However, we will return to Greensboro on Monday, March 19, 2018 in time for students to attend school if they choose to do so. If you check in to school late or check out from school early on Monday, March 19, 2018, you must follow all school rules regarding arriving late or leaving early. Students are expected to attend school on Thursday, March 15, 2018 and Tuesday, March 20, PLEASE KEEP THIS PAGE FOR YOUR RECORDS

3 To secure your student s reservation, complete the trip forms (pages 1-6) and return them with your $200 payment (non-refundable deposit) to Donya Mullins (721 Coleridge Drive, Greensboro NC 27410) by Friday, November 3, The trip cost increases to $850 after November 3, THE NOTARIZED MEDICAL RELEASE AUTHORIZATION FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY. We will have a notary at the Band Covered Dish Dinner in November (TBA). Trip forms and payments are not accepted at school. A student will not travel unless his/her trip is paid in full by Friday, February 2, Students will receive fundraising credit information after the completion of all band fundraising activities. PAYMENT SCHEDULE Checks payable to GHS Band Boosters Friday, November 3 $200 Payment #1 Non-refundable Deposit and Trip Forms Payment #1 is $350 for students signing up after November 3, 2017 Friday, December 1 $200 Payment #2 Friday, January 5 $200 Payment #3 Friday, February 2 $200 Payment #4 For donations to the trip scholarship account, please mail your check payable to GHS Band Boosters to Donya Mullins (Grimsley Band Boosters, 721 Coleridge Drive, Greensboro NC 27410). Tentative date for mandatory student and parent pre-trip meeting Tuesday, March 6, 2018 Questions Donya Mullins ( or donya201@gmail.com) PLEASE KEEP THIS PAGE FOR YOUR RECORDS

4 CHECKLIST FORM FORM NAME PAGE NUMBER DUE DATE SEND TO Student Information Form 1 11/03/17 Donya Mullins Field Trip Permission Form 2 11/03/17 Donya Mullins Behavioral Contract Form 3 11/03/17 Donya Mullins Medical Information Form 4 11/03/17 Donya Mullins Notarized Medical Form 5 11/03/17 Donya Mullins Roommate Request Form 6 11/03/17 Donya Mullins Payment Coupon #1 $200 11/03/17 Donya Mullins Payment #1 is $250 for students signing up after November 3, 2017 Payment Coupon #2 $200 12/01/17 Donya Mullins Payment Coupon #3 $200 01/05/18 Donya Mullins Payment Coupon #4 $200 02/02/18 Donya Mullins *Optional Donation Payment Coupon Donya Mullins * Scholarship Application Form 11/03/17 Donya Mullins * Chaperone Sign-Up Form 11/03/17 Donya Mullins * The Optional Donation Payment Coupon only applies to families making a donation to the band trip scholarship fund * The Scholarship Application Form only applies to students applying for scholarship funds * The Chaperone Sign-Up Form only applies to adults volunteering to chaperone the trip PLEASE KEEP THIS PAGE FOR YOUR RECORDS

5 STUDENT INFORMATION FORM PAGE 1 of 6 Please return trip forms (pages 1-6) with your $200 payment (non-refundable deposit) and payment coupon #1 by Friday, November 3, All trip forms and payments should be mailed to Donya Mullins (721 Coleridge Drive, Greensboro NC 27410). Student Name Student Address Home Telephone Student Student Mobile Parent Name Parent Parent Telephone We will use band to notify parents of our expected arrival time at Grimsley High School on Monday, March 19, Please make sure the band has your address by sending an to webmaster@grimsleyband.com or by signing up for band s on the band website ( Join our contact list). Do you plan to apply for scholarship funds to help pay for this trip? ( ) Yes ( ) No Performing Group(s)( ) Marching Band Instrument ( ) Drum Line Instrument ( ) Jazz Band Instrument ( ) Concert Band Instrument School Class ( ) Freshman ( ) Sophomore ( ) Junior ( ) Senior T-shirt Size ( ) Adult Small ( ) Adult Medium ( ) Adult Large ( ) Adult X-Large ( ) My child WILL participate in the Grimsley High School Band 2018 Spring Trip to Universal Studios, Universal Studio s Islands of Adventure and SeaWorld in Orlando, Florida. ( ) My child WILL NOT participate in the Grimsley High School Band 2018 Spring Trip to Universal Studios, Universal Studio s Islands of Adventure and SeaWorld in Orlando, Florida. This is the only form that should be returned if your student is not participating in the trip. MAIL THIS FORM, $200 PAYMENT AND PAYMENT COUPON #1

6 GUILFORD COUNTY SCHOOLS FIELD TRIP INFORMATION/PERMISSION FORM PAGE 2 OF 6 SCHOOL Grimsley High School A field trip has been planned that will serve as an enrichment experience for those students participating. The trip will serve as a preparatory/follow-up activity to enrich a regularly scheduled part of the instructional program. Students will not be allowed to make the trip unless parental permission is granted. The school system is responsible for students based on the laws of the state of North Carolina. In the event that an accident happens, medical assistance should be sought immediately. The parent will be contacted, and medical charges will be assigned to the parent or guardian. The behavior of our students as it relates to a field trip is of critical importance. Students are always expected to be on their best behavior. Regrettably, inappropriate behavior can result in disciplinary action, including in extreme cases being returned home separately at the parent s expense. The following details are provided for your information: DESTINATION Orlando, Florida (Universal Studios, Universal s Islands of Adventure and SeaWorld) SUPERVISING TEACHER Dr Stefan R Stuber DEPARTURE DATE Thursday, March 15, 2018 TIME 8:00 pm RETURN TO SCHOOL Monday, March 19, 2018 TIME 10:00 am METHOD OF TRANSPORTATION Deluxe Motor Coaches COST $ OTHER MONIES NEEDED (Admission, etc.) Spending money, souvenirs, and snacks ARRANGEMENT FOR MEALS Included in trip package PARENTS Please complete this form and return the sheet along with other trip forms by Friday, November 3, I hereby certify that (student s name) has permission to participate in the field trip according to the policies and provisions as stated above. In the event of an accident or medical emergency, I authorize the supervising teachers to seek medical assistance, and I will assume responsibility for all expenses. I authorize the following medications. Initial those applicable: none to be taken authorized per existing Authorization of Medication for a Student at School form authorized per the attached special authorization form (submit the Authorization of Medication... form found at Procedure JGCD-P to include medicines beyond the normal school day during this trip). Parent Signature Date Phone Number Address Student Date of Birth Doctor s Name Phone Number Insurance Company Policy Number If parents cannot be located in the event of an emergency, contact: Name Phone Number Address MAIL THIS FORM, $200 PAYMENT AND PAYMENT COUPON #1

7 BEHAVIORAL CONTRACT FORM PAGE 3 OF 6 While on this trip, you are at school 24/7 and all school rules apply for the entire trip. This includes your behavior in the hotel, attractions, restaurants, theme parks, and on the buses, as well as behavior towards theme park employees, tour guides, bus drivers, and other students and adults on this trip. The school dress code applies at all times. If you cannot do it or wear it at school, you cannot do it or wear it on this trip. Please remember that you are representing Grimsley High School and Greensboro at all times while on this trip. It is imperative that this is clearly understood by all students and parents. If we are unable to insure appropriate behavior on band trips, then we are placing future trips in serious jeopardy. You are required to attend school on Thursday, March 15, 2018 and Tuesday, March 20, You can attend school on Monday, March 19, 2018 or use that day to catch up on sleep and complete school assignments so that you will be ready for school on Tuesday, March 20, The behavior of the students on this trip and their school attendance on Thursday, March 15, 2018 and Tuesday, March 20, 2018 determines whether the band goes on future trips. Your behavior on this trip can affect your ability to participate in other school activities such as sports, prom or graduation ceremonies. PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE SIGNING THIS BEHAVIOR CONTRACT I, the undersigned, will not knowingly possess, use, transmit, or be under the influence of any narcotic drug, hallucinogenic drug, amphetamine, barbiturate, marijuana, alcoholic beverage, or intoxicant of any kind. I understand that this is a supervised program and that group standards must be observed. I will at all times remain under the supervision of Grimsley High School, its agents, employees, and chaperones and will comply with the Grimsley High School rules, Guilford County Schools Code of Conduct, standards and instructions for student behavior. I hereby waive and release all claims against Grimsley High School, its agents, employees, and chaperones arising out of my failure to remain under such supervision or to comply with such rules, standards, and instructions. I agree that Grimsley High School, its agents, and chaperones shall have the right to enforce appropriate standards of conduct and that they may at any time terminate my participation for failure to maintain these standards or for any actions or conduct which Grimsley High School considers incompatible with the interest, harmony, comfort, and welfare of the other students. If my participation is terminated, I consent to being returned home by the most convenient transportation at my parents expense. I realize this type of behavior will be subject to suspension and/or dismissal from school in accordance with school rules. Realizing that activities of an individual or a few can cause severe damage to the reputation and integrity of an entire group, school, and community, I am responsible for my actions and shall conduct myself appropriately at all times. Students who have any administrative discipline referrals are not allowed to participate in the trip and are not eligible for a refund of trip payments. Student Signature Date I certify that I am the parent or legal guardian of the above student and that I have read and fully understand this policy with special regard to its seriousness and consequences. I hereby relinquish claim that I might have against Grimsley High School, its agents, employees, and chaperones both in my own behalf and in my capacity as legal representative of the student in matters covered in the above policy. I also understand that I am responsible for any bank fees incurred for payments not honored by financial institutions. These fees must be paid by Friday, February 2, If my student signs up for this trip and later withdraws, I must notify the band booster organization of this decision in writing. The date my student withdraws and the trip expenses incurred at that time will determine if I receive a refund of any payments made prior to my withdrawal. Students who have any administrative discipline referrals are not allowed to participate in the trip and are not eligible for a refund of trip payments. Parent or Guardian Signature Date *All references to Grimsley High School, its agents and employees shall include Grimsley High School and all its officers, directors, administrators, employees, staff members, counselors, group leaders, chaperones, and agents. MAIL THIS FORM, $200 PAYMENT AND PAYMENT COUPON #1

8 GRIMSLEY HIGH SCHOOL MEDICAL INFORMATION FORM PAGE 4 OF 6 Student s Full Name Date of Birth Gender Present Age Present Grade Father s Name Mother s Name Legal Guardian Address City Zip Code Telephone (Home) Work (Father) Work (Mother) Mobile (Father) Mobile (Mother) Relative or Other Responsible Party Phone Family Physician Phone Family Dentist Phone Preferred Hospital School Insurance? ( ) Yes ( ) No Family Insurance Policy Number Please include a photocopy of your medical and dental insurance cards. If your insurance coverage changes prior to the trip, please send updated information. This includes employers who change their carriers at the beginning of the enrollment year. MEDICAL HISTORY Drug Allergies Anesthesia Allergies Food Allergies Other Allergies Medical Conditions Currently Under Treatment Braces? ( ) Yes ( ) No Contacts? ( ) Yes ( ) No Glasses? ( ) Yes ( ) No Medications Currently Taking Physical Disabilities ( ) Asthma ( ) Bleeding Disorder ( ) Convulsive Disorder ( ) Diabetes ( ) Kidney Disease ( ) Rheumatic Fever ( ) Sickle Cell ( ) Other Past Surgery? ( ) Yes ( ) No If so, when and for what? Date of Last Tetanus Shot Special Health Problems MAIL THIS FORM, $200 PAYMENT AND PAYMENT COUPON #1

9 NOTARIZED MEDICAL RELEASE AUTHORIZATION FORM PAGE 5 OF 6 Please complete and sign the medical release below. You must sign it in the presence of a notary. Your child will not be permitted to attend the band trip without a signed, notarized medical release authorization form. I, the parent (or legal guardian) of, give my permission to Grimsley High School Music Department staff and approved chaperones to act as guardian by consenting to medical treatment for my child in the event of an accident, emergency, or serious illness if I cannot be reached. This would include administration of medication and any treatment the attending medical staff deems necessary to the health and welfare of my child. This authorization expires immediately upon my child s return to me at the conclusion of the band trip (March 19, 2018). Parent/Guardian Signature Date STATE OF NORTH CAROLINA COUNTY OF GUILFORD On this of of. date month year Notary My commission expires on: Grimsley High School does not require that students carry medical or dental insurance. However, any medical or dental expenses that may result from injury or illness while a student is on the band trip will be the responsibility of their parent(s) or guardian(s). School insurance may be purchased if there is no family or individual coverage from another source. MAIL THIS FORM, $200 PAYMENT AND PAYMENT COUPON #1

10 ROOMMATE REQUEST FORM PAGE 6 OF 6 Student Name Home Telephone Student Student Mobile Performing Group(s) ( ) Marching Band Instrument ( ) Drum Line Instrument ( ) Jazz Band Instrument ( ) Concert Band Instrument School Class ( ) Freshman ( ) Sophomore ( ) Junior ( ) Senior Band Class Periods To help us in making room assignments, please list up to THREE people you would like to room with on the spring band trip. We will try to place you with at least one of these people. Please be sure that your roommate choices are students planning to go on the trip. If you are waiting to hear from your scholarship application, please fill out a roommate form so we ll know where to hold a spot for you. There will be FOUR students assigned to each room. The roommate lists will be distributed with other trip information at the MANDATORY student/parent trip meeting on Tuesday, March 6, 2018 (tentative date) MAIL THIS FORM, $200 PAYMENT AND PAYMENT COUPON #1

11 PAYMENT COUPONS PAGE 1 OF 2 Use these coupons when making trip payments by check. Please write your student s name on each coupon and on the memo line of your check. If you are paying by money order, cashier s check or official check, be sure you keep a copy of the check or receipt. Deduct fundraising incentives from payment #4 (due Friday, February 2, 2018). Mail payment #1 and the trip forms (pages 1-6) to Donya Mullins (721 Coleridge Drive, Greensboro NC 27410) by Friday, November 3, Mail payment #2, payment #3, payment #4 and donations for the trip scholarship fund to Donya Mullins (721 Coleridge Drive, Greensboro NC 27410). Payment #1 (non-refundable $200) and trip forms (pages 1-6) must be received by Friday, November 3, 2017 to reserve a space for your student. No student will travel unless his/her trip is paid in full by Friday, February 2, NON-REFUNDABLE DEPOSIT PAYMENT #1 - $200 DUE 11/03/17 $350 DUE IF POSTMARKED AFTER 11/03/17 Student Make check payable to GHS Band Boosters Send check and payment coupon with trip paperwork (pages 1-6) to: Donya Mullins Grimsley Band Boosters 721 Coleridge Drive Greensboro NC PAYMENT #3 - $200 DUE 01/05/18 Student Make check payable to GHS Band Boosters Send check and payment coupon to: Donya Mullins Grimsley Band Boosters 721 Coleridge Drive Greensboro NC PAYMENT #2 - $200 DUE 12/01/17 Student Make check payable to GHS Band Boosters Send check and payment coupon to: Donya Mullins Grimsley Band Boosters 721 Coleridge Drive Greensboro NC PAYMENT #4 - $200 DUE 02/02/18 Student Make check payable to GHS Band Boosters Send check and payment coupon to: Donya Mullins Grimsley Band Boosters 721 Coleridge Drive Greensboro NC PLEASE ATTACH THESE COUPONS TO YOUR PAYMENT

12 PAYMENT COUPONS PAGE 2 OF 2 *** OPTIONAL *** Donation to trip scholarship fund to help deserving band students participate in the trip Donor Make check payable to GHS Band Boosters Send check and payment coupon to: Donya Mullins Grimsley Band Boosters 721 Coleridge Drive Greensboro NC PLEASE ATTACH THIS COUPON TO YOUR PAYMENT

13 SCHOLARSHIP APPLICATION FORM If you are applying for scholarship funds, you must complete this form and return it, along with the trip forms (pages 1-6) and $200 payment, by Friday, November 3, 2017 to Donya Mullins (721 Coleridge Drive, Greensboro NC 27410). The Band Boosters will give up to five $ trip scholarships. The remainder of the trip fee will be the responsibility of the student and/or parents. Criteria to receive scholarship funds are as follows: Must have at least a 2.0 grade point average in the first quarter of the school year Must be present at Grimsley at least 85% of the school year Must have no referrals to the school administration related to behavior for the school year Must participate in Band Booster fundraisers o Attractions Books (September 2017) and/or Fruit Sale (November 2017) Student Name Grade Parent Names Please attach an essay (estimated 50 words) explaining what this band trip would mean to you and why you are applying for scholarship funds. Include information about band, music, school, athletic, service and community activities you are involved in. MAIL THIS FORM, $200 PAYMENT AND PAYMENT COUPON #1

14 CHAPERONE SIGN-UP FORM A limited number of complimentary packages are available for our music director and school administrator. If you are interested in accompanying our students as a chaperone, please complete this form and return it to Donya Mullins by Friday, November 3, We will contact chaperones regarding the chaperone trip price and the pre-trip chaperone meeting that will be held a week prior to the student/parent trip meeting. There will be a MANDATORY student/parent trip meeting on Tuesday, March 6, 2018 (tentative date). Name Address Home Telephone Work Telephone Mobile Telephone Address Student s Name Parent T-shirt Size ( ) Adult Small ( ) Adult Medium ( ) Adult Large ( ) Adult X-Large PLEASE READ THE FOLLOWING INFORMATION REGARDING TRIP CHAPERONE REQUIREMENTS Each adult chaperone will be responsible for a group of approximately ten to twelve students, accompanying them on the bus to and from Orlando, Florida, staying in assigned hotel rooms, accompanying students to activities, and performing other duties as necessary. If you have questions about chaperone responsibilities, please contact Donya Mullins ( or donya201@gmail.com). PLEASE MAIL THIS CHAPERONE FORM TO:

CHAMPAIGN COMMUNITY UNIT SCHOOL DISTRICT NO. 4 Champaign, Illinois FIELD TRIP PERMIT

CHAMPAIGN COMMUNITY UNIT SCHOOL DISTRICT NO. 4 Champaign, Illinois FIELD TRIP PERMIT FIELD TRIP PERMIT (School) (Student s Name) (Teacher/Sponsor) (Telephone Number) PARENTS/GUARDIANS: A field trip to is planned for (class or group) on. The trip will begin at a.m./p.m. and return at a.m./p.m.