Registration & Commitment Form New York City Trip March 30 - April 3, 2017

Transcription

1 Please print clearly Registration & Commitment Form New York City Trip March 30 - April 3, 2017 Due Friday, September 9 in main office with: $50 non-refundable deposit Acknowledgment of Risk & Hold Harmless Agreement Volunteer Chaperone Agreement (optional) Student Name: Ensemble: Student Cell Phone #: Student Parent Name: Parent Cell Phone #: Parent I, (parent full name), understand and will abide by the regulations in the registration packet. I understand that signing below is committing my child to the trip, and if I elect to cancel, am subject to the cancellation policy outlined by WorldStrides. I understand that failure to follow the payment schedule will result in immediate cancellation of my student s trip and any refund will be determined according to the cancellation policy outlined by WorldStrides. I understand that if my student does not meet the musical or academic requirements outlined in the packet and by the director, the result will be immediate cancelation and any refund will be determined according to the cancellation policy outlined by WorldStrides. I understand that the $50.00 deposit due with this form is non-refundable and will go towards the price of my child s trip. Yes, I would like to chaperone and will commit to the additional payment schedule. **Please list previous chaperoning experiences on the back of this form, or check here if this would be your first time chaperoning ** Parent Signature Date I, (student full name), understand and will abide by the regulations in the registration packet. I understand that signing below is committing myself to the trip and I will meet all the musical and academic requirements outlined in the packet and by my director. Failure to do so, or to make payments on time, will result in immediate cancellation and any refund will be determined according to the cancellation policy outlined by WorldStrides. Student Signature Date

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3 New York City Trip Registration Packet Dates: Thursday, March 30 - Monday, April 3, 2017 Participants: Symphonic Orchestra, Chamber Orchestra, Concert Choir, Bella Voce, Chamber Choir, Concert Band, Symphonic Band Chaperone Expense: $1000 Sponsors: Paul Trapkus, Jeremy Skelton, Bill Legg, WorldStrides OnStage Programs Student Expense: $1600-$1900 exact price will depend on number of participants, airfare, and hotel rates Educational Objective: Band, choir, and orchestra students will participate in a WorldStrides Heritage Festival performance and receive feedback and a clinic from nationally acclaimed adjudicators. Students will explore the musical and cultural worlds of New York City with visits to a Broadway show, Carnegie Hall, the Lincoln Center, and more. Through these unforgettable experiences, students will grow musically and apply the lessons learned to their ensembles and future musical endeavors. Trip Tentatively Includes: * Round trip airfare from Denver to New York * Subway and ground transportation in NYC * 5-day/4-night core Heritage Festivals Package (lodging, performances, adjudications, clinics, awards ceremony) * Dinner Cruise around Manhattan Island * Two additional group dinners * Broadway show * Broadway workshops * Carnegie Hall tour * Statue of Liberty * One World Observatory (World Trade Center) * 9/11 Museum * American Museum of Natural History * Museum of Modern Art * Lincoln Center Tour * Radio City Music Hall Tour * Chinatown * Central Park * Metropolitan Museum of Art Student Payment Schedule 1. Friday, September 9, 2016 $50 w/ Registration Form (non-refundable) 2. Friday, October 7, 2016 $ Friday, November 4, 2016 $ Friday, December 9, 2016 $ Friday, February 3, 2017 $ Friday, March 3, 2017 Final amount minus accumulated fundraising money Chaperone Payment Schedule 1. Friday, September 23, 2016 $50 (non-refundable) 2. Friday, October 7, 2016 $ Friday, November 4, 2016 $ Friday, December 9, 2016 $ Friday, February 3, 2017 $ Friday, March 3, 2017 $200 All checks should be made out to SCOPA and given to the main office no later than 2:45 p.m. on the due date. Failure to make any payment by the posted date may result in immediate cancellation. Any refund will be determined according to the cancellation policy outlined by WorldStrides.

4 Academic Requirements Students must be academically eligible March Students serving in or out of school suspension during this time will not be allowed to travel unless Mr. Finnestead gives permission. Failure to meet the academic requirements will result in immediate cancelation, and any refund will be determined according to the cancelation policy outlined by WorldStrides. Musical Requirements Students must demonstrate knowledge of festival repertoire prior to departure. For choir students, all music must be memorized. Teachers will communicate further details regarding musical requirements to students in each ensemble. Failure to meet these requirements will result in immediate cancelation, and any refund will be determined according to the WorldStrides cancelation policy. WorldStrides Cancelation Policy Worldstrides programs, which travel by air, are generally booked on promotional airfares. These fares have certain restrictions and/or penalties regarding reservations and cancellations. In the event of any cancellation of any reservation after the air carrier has issued an airline ticket, the participant shall forfeit the amount of the airline cancellation penalty in addition to the other cancellation penalties listed below. In the event the school or any participant desires to cancel a reservation, all cancellations must be made in writing by or on behalf of the person listed on the registration form through their director to WorldStrides, P.O. Box , Salt Lake City, UT , must be postmarked prior to the group s departure, and must include the trip identification number provided at the time of registration, registrant s name and complete address. Upon such a cancellation, and subject to all other provisions of this paragraph, the participant shall only be entitled to a refund on the following basis and there shall be no other refunds, including for unused services or program features after the group departs: a. If the reservation is canceled by the school, Director or participant, within seven calendar days following receipt of written confirmation or initial payment invoice (whichever is received first), the WorldStrides program may be canceled and a full refund issued. b. If cancellation occurs beyond the seven day grace period but at least forty-five (45) days prior to departure, WorldStrides will refund all amounts paid less a $35 processing fee per person, any amounts relating to the group deposit, and all applicable fees and penalties levied by airline, hotels, bus companies, retailers and other vendors. c. If the reservation is canceled by the school, Director or participant, less than forty-five (45) days but more than seven (7) days prior to departure, WorldStrides will charge a 50% cancellation fee based on program price (including any amounts relating to the group deposit) plus and all applicable fees and penalties levied by airline, hotels, bus companies, retailers and other vendors. d. If the school, Director or participant cancels the reservation less than seven (7) days prior to departure, no refund will be given. Chaperones Once the number of participants has been determined, we will need at least 1 chaperone per 15 students. If interested, please provide the appropriate information on the Registration & Commitment form and the district Volunteer Chaperone Agreement. The cost for chaperones is $1000 and there is a separate payment schedule that will need to be followed. Failure to do so will result in immediate cancellation and any refunds will be determined by the cancellation policy of WorldStrides. The directors will determine the chaperones based on meeting the requirements of SVVSD, equal distribution between choir and orchestra, and chaperoning experience. Only parents or grandparents of students will be asked to chaperone. Once we decide who will be chaperoning, we will send out an to all parents and then those chaperones will need to follow the chaperone payment schedule. In the event that we cannot meet the chaperoning demands, the trip will be cancelled. Fundraising SCOPA Bingo Sessions All trip participants (students and parents) are encouraged to volunteer at the SCOPA Bingo sessions to help lower the trip cost. Special additional sessions are now being held once a month through January with proceeds going directly to the travel fund for this trip. This fund will reduce the final payment amount for all students going on the trip. To sign up for one of these sessions, talk to Mr. Skelton, Mr. Legg, or Mr. Trapkus. King Soopers / Safeway Reloadable Gift Cards All trip participants are encouraged to obtain at least one King Soopers or Safeway gift card from their teacher designated specifically for the New York trip. Whenever you load money onto the card, King Soopers or Safeway donates 5% of that amount to our trip fund, which will reduce the final payment amount for all students going on the trip. If you already have one of these cards for band, choir, or orchestra, we encourage you to switch to the travel fund card from now through January 31.

5 Procedure Page E Revision 8 ACKNOWlEDGEMENT Of RISK & HOlD HARMlESS AGREEMENT for Overnight Trips Sponsored by St. Vrain Valley School District RE-lJ STUDENT NAME: GRADE PHONE. LAST, FIRST (please print) School/Group: Travel Dates: Travel Destination: Group Leader: ACKNOWlEDGEMENT Of RISK We acknowledge that the above named student (herein, "Participant") could sustain various injuries and illnesses, including physical injury, death, or other consequences arising or resulting from participation in this trip. BY ITS NATURE, PARTICIPATION IN THIS TRIP INCLUDES A RISK OF INJURY WHICH MAY RANGE IN SEVERITY FROM MINOR TO LONG-TERM CATASTROPHIC OR EVEN DEATH. Furthermore, injuries sustained while participating in this trip could result in a serious impairment of Participant's future abilities to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life. Although serious injuries are not common in supervised school sponsored trips, it is impossible to eliminate all risk. Participants can help and have the responsibility to reduce the chance of injury by following instructions and adhering to applicable rules and regulations. SUPERVISION PlAN Participants will be supervised by certified staff, not to exceed thirty students per certified employee. In addition, volunteers (who must be at least 21 years old and satisfy a background check) will assist with supervisory duties under the direction of certified staff, not to exceed 15 students per volunteer chaperone. RESPONSIBiliTY FOR MEDICAl BILLS AND EMERGENCY CARE In consideration of the possibility of an accident, we hereby consent to emergency transportation and treatment necessary in the event of injury or illness. We hereby accept responsibility for the payment of any emergency transportation and treatment expenses and any subsequent medical bills. We acknowledge that the St. Vrain Valley School District DOES NOT purchase health or accident insurance for students participating in school trips (except for injuries sustained in district vehicles). If you are interested in purchasing voluntary student accident insurance, please contact the school office. Only the 24-hour coverage plan would cover this trip. If you have already purchased the school-time-only coverage (which would not cover this trip), it may be upgraded to the 24-hour coverage plan by paying the premium difference.

6 Procedure Page F Revision B ASSUMPTION OF RISK AND RElEASE OF All ClAIMS We hereby assume all risk of injury and/or property damage or loss, and waive any right of recovery from, or to bring suit against, the St. Vrain Valley School District, its employees, volunteers, or agents, for any personal injury, death, or other consequences, including property damage or loss, sustained or incurred by Participant and arising out of participation in this trip. This release is not to be construed as a contractual waiver by the District of any immunities or defenses provided to the District by the Colorado Governmental Immunity Act, or by other statutes or common law. INDEMNIFICATION We agree to indemnify and hold harmless the St. Vrain Valley School District, its agents or employees from all loss, costs, damage, injury, liability, claims and causes of action whatsoever, asserted by any third party and arising out of or directly related to Participant's negligent and/or intentional acts, errors and omissions while participating in any aspect of this trip. PARENT OR GUARDIAN PERMIT Parent/guardian hereby gives permission for student named above to participate in this trip. ************************************************************************************************* Participant and parent/guardian have thoroughly read the statements and conditions stated above under the headings: ACKNOWlEDGEMENT OF RISK, SUPERVISION PlAN, RESPONSIBUTY FOR MEDICAl BillS AND EMERGENCY CARE, ASSUMPTION OF RISK AND RElEASE OF All ClAIMS, INDEMNIFICATION, AND PARENT OR GUARDIAN PERMIT. We understand and agree to the terms of this Agreement, which is a legally binding document, as noted by the following signatures: Student (Participant) Signature Date Parent/Guardian Signature Date ************************************************************************************************* NOTE: Each school is to retain a copy of the signed agreement for each participant in the school office. The retention period for the agreements is seven years. A signed copy must be on file prior to participation. COMPlETED Date Signature of School Official Aug2012 RMS

7 St. n Val District {SVVSD) Procedure 619-i Page C Revision B Volunteer Chaperone reement Becoming a Volunteer Overnight Trip Chaperone SWSD requires that volunteer chaperones be at least 21 years old and agree to a background check. Background checks are conducted in the SWSD Human Resources Department at 395 S. Pratt Parkway in Longmont, Monday through Friday, 8:00AM to 4:00 PM. Volunteer Chaperone Duties and Responsibilities The supervising staff member will provide you with information regarding the activities planned for the trip, expectations for supervising students, and emergency procedures. In addition, the following guidelines will help you perform your duties as a chaperone. If you have any questions regarding your assignment, please contact the supervising staff member or the building Principal or program manager. 1. All school rules apply on District-sponsored trips. Chaperones are expected to comply with SWSD policies, follow the directions given by the supervising staff member, work cooperatively with other staff and volunteers, and model appropriate behaviors for students. 2. In order to comply with SWSD policy, while acting as chaperones, volunteers: a. shall not use, sell, provide, possess, or be under the influence of drugs or alcohol b. shall not use tobacco in the presence of, or within the sight of, students c. shall not possess any weapon d. shall not administer any medications, prescription or nonprescription, to students 3. Students must be supervised at all times while traveling and participating in activities. As a chaperone, you will supervise a small group of students, helping them learn and making sure they behave appropriately. Students must stay with you, their chaperone, at all times. Go over use of the buddy system with students under your care. Account for all participants regularly and before changing activities. Chaperones must report any missing student to the staff member immediately. Be sure you know when and where to meet the rest of your group. Chaperones must be readily available, be mindful of safety concerns, and respond to students' needs. 4. Student behavior is your responsibility. School rules related to student behavior apply. Go over rules and standards of behavior, safety rules, and any site specific rules with students. Report any discipline issues to the staff member immediately. 5. Ensure that students do not get involved in extra activities not pre-approved by SWSD administrators. 6. For the protection of both the student and the chaperone, chaperones shall not place themselves in situations in which they are alone with a student. 7. Family members or friends of a chaperone may not participate in a District-sponsored overnight trip or event unless prior approval has been obtained from the Area Assistant Superintendent, and if an adult, shall also be required to submit to a background check. Additional small children can distract you from your duties as a chaperone. 8. Be sure to know what to do in an emergency (medical emergency, natural emergency, lost child, serious breach of rule, etc.). Know who is first aid trained, where the first aid kit is, where the cell phone is kept, and who has the copies of parental permission slips with emergency phone numbers and medical information.

8 Procedure PageD Revision B Volunteer Insurance Volunteers who are acting within the scope of their assigned duties under the direction of SWSD are deemed "employees" and are afforded protection under the Colorado Governmental Immunity Act and are covered by SWSD's liability insurance. Volunteers shall notify the school Principal and the SWSD Risk Manager of any occurrence that might result in a liability claim by any third party, including students. Volunteers are not deemed to be employees of the SWSD for any other purpose except as explained in the preceding. Volunteers are not covered by SWSD's workers' compensation insurance policy. SWSD does not purchase accident or health insurance for volunteers, and all volunteers are urged to obtain personal medical health insurance in case of an emergency. Any injury or illness sustained by the volunteer, and any resulting medical care that may be required, arising out of or in the course of performing volunteer duties, is the sole responsibility of the volunteer. Volunteers who transport students in their personal vehicle must complete the SWSD Student Transportation in Private Vehicles form EEAG-E for approval by the building Principal, and must comply with all District and State student transportation rules and regulations. The volunteer's personal vehicle insurance provides primary coverage in the event of an accident or injury. ******************************************************************************************************************** Who to contact if the Volunteer Chaperone has a personal emergency: Emergency contact's name Contact's daytime phone Contact's night phone Relationship to volunteer chaperone (e.g. friend, neighbor, spouse) ******************************************************************************************************************** AGREEMENT I, the undersigned Volunteer, acknowledge that I have thoroughly read, and agree to, the terms of the "Volunteer Chaperone Agreement". Volunteer's Printed Name Volunteer's Signature Date Thank You for Your Support SVVSD recognizes that off-campus activities provide an extended educational experience for students. We thank volunteer chaperones like you very much for giving your time and support to make these activities possible. This Agreement is intended to help ensure a safe and rewarding experience for all participants. Aug2012 RMS