Document 253171

 ThunderRidge High School
Performing Arts
California Trip
March 21-25, 2013
st
Trip Meeting Monday, October 1 in TRHS Auditorium
Join Us!
TRHSmusic.com
TRHS Performing Arts California Trip
TRHS Band, Orchestra, Choir, and Theater
March 21-25, 2013
What? A 5 day, 4 night trip to Southern California including Disney Land,
Universal Studios, Knott’s Berry Farm, Medieval Times, and more.
When? March 21-25, 2013
Who can go? Any student in TRHS Band, Orchestra, Choir, & Theater. Parents
and family members are also welcome.
How much?
Price per traveler
$1245.00
$1295.00
$1395.00
$1695.00
People per room
4
3
2
1- adults only
Price includes: All transportation (air, bus, etc.), parks admission fees, daily
breakfast, beach bbq, Pizza dinner (see itinerary), Medieval Times dinner and
show, and much more. Price does not include: Lunches daily, two dinners, and
spending money.
Can parents and family go? Yes, Parents and family are always welcome. We
would like a few parents to help chaperone. TRHS alumni are welcome as long as a
parent goes too.
Are there fundraising opportunities? Yes, one of the best fundraising
opportunities is our King Soopers gift card program. In addition to the gift cards
we will offer other opportunities for raising money. Talk to your teacher for
fundraising programs.
When do I have to pay?
Payment Schedule
Date Due
10/15/2012
11/15/2012
12/15/2012
1/15/2013
Minimum amount due per traveler
$100.00 (non-refundable)
$400.00
$400.00
Trip balance due
What if I need to cancel my/our trip?
-The first deposit of $100.00 is non-refundable. 90-60 days before the trip all
but $600.00 of the money paid is refundable. Less than 60 days before the trip,
no money will be refunded.
-Optional trip insurance, with “Cancel-For-Any-Reason” feature, is available for
purchase directly from Celestial Travel. See website for trip insurance application
and information. We highly recommend the purchase of this insurance. This
insurance will reimburse you 75% of trip costs paid if you need to cancel. The
insurance covers many other situations too.
How do I sign up?
Go to TRHSmusic.com, click “California Trip” and follow the steps. Please complete
all required forms included in this packet for each traveler in your family. These
forms are also available online at the link above.
To be considered a member of this trip, please complete and return all
forms, and pay your 1st deposit no later than October 15.
For more information contact your Performing Arts teacher or:
Mike Snell at TRHS
e-mail: [email protected]
Phone: 303-387-2123
Website: www.TRHSmusic.com - select “California Trip”
Itinerary #10
ThunderRidge High School
Performing Arts Department
Los Angeles Performance Tour
March 21 – 25, 2013
(5 day/4 night)
Thursday, March 21, 2013
Meet your Celestial Travel & Tours representative 2 hours prior to
departure at Denver International Airport. Each traveler must have
a valid ID (i.e. student ID, driver’s license, driver’s permit) that
matches their ticketed name
Each traveler should have a filled out Celestial Travel & Tours
luggage tag on their checked suitcase. Most instruments can be
carried on, along with a backpack or purse
The group departs for California via Southwest Airlines
The group arrives at the Los Angeles International Airport and
retrieves their luggage and instruments
Everyone boards the motor coaches and transfers downtown for
sightseeing. Enjoy strolling the Hollywood Walk of Fame and visit
the Kodak Theatre, Mann’s Chinese Theatre and Hollywood and
Hyland Complex.
Everyone boards the motor coaches and heads south to Corona
Del Mar Beach for swimming and a beach BBQ
Late afternoon the group boards the motor coaches to transfer to
the hotel for check in. Room packets will be ready and the tour
manager expedites this process
3045 S. Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-359-7200 Fax: 720-248-3718
E-mail: [email protected]elestialtrvl.com www.celestialtravel.net
Thursday, March 21, 2013
The group returns to the hotel
Everyone freshens up and walks to the Buena Park Mall. While
there we will visit John’s Incredible Pizza Company to enjoy an
unlimited pizza, salad and dessert buffet. Token cards will be given
so everyone can enjoy the games, rides, bowling, arcade, etc.
The group meets at the designated location and walks back to the
hotel
Everyone in their rooms
Lights out!!!
Friday, March 22, 2013 – Performance Day!
Wake up call
Breakfast at the hotel
Dress for a casual day at the park, with performance wear being
transported by the motor coaches. A hat and sunscreen are
recommended!
Load uniforms and instruments and boards the motor coaches to
Disneyland Park (Disney Performing Arts Onstage Program)
Arrive and spend the day at Disneyland P ark . A designated
meeting place and time will be reviewed prior to departing the
motor coaches. Instruments and performance wear will remain on
the motor coaches, which will remain on the park grounds for the
day, but will not be accessible except for designated performance
times
The Park Hopper pass allows everyone to travel freely between the
two parks (Disneyland and the California Adventure Park)
Lunch and Dinner at park (at own expense)
At the designated time, a motor coach attends a vehicle inspection
at the before entering at the pre-production area
3045 S. Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-359-7200 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
Friday, March 22, 2013 – Performance Day! – (cont.)
Orchestra students and director meet the Stage Manager at the
Toontown Entrance. The Stage Manager will issue a welcome and
escort the musicians to the motor coach to unload their
instruments and performance attire, and escort the group to their
dressing rooms to ready for their performance
It’s Showtime for the Thunder Ridge High School Orchestra!!
The performance is concluded by the Orchestra. Everyone changes
out of their performance attire and loads instruments and
performance wear onto the motor coach. The group will re-enter
the park at the Toontown Gate
Choir students and director meet the Stage Manager at the
Toontown Entrance. The Stage Manager will issue a welcome and
escort the group to the motor coach to unload their performance
attire, and escort the group to their dressing rooms to ready for
their performance
It’s Showtime for the Thunder Ridge High School Choir!!
The performance is concluded by the Choir. Everyone changes out
of their performance attire and loads them onto the motor coach
The group will re-enter the park at the Toontown Gate
At the designated time, the motor coach attends a vehicle
inspection at the before entering at the pre-production area
Marching Band students and director meet the Stage Manager at
the Toontown Entrance. The Stage Manager will issue a welcome
and escort the musicians to the motor coach to unload their
instruments and performance attire, and escort the group to their
dressing rooms to ready for their performance
It’s Parade Time for the Thunder Ridge High School Marching
Band!!
The performance is concluded by the Marching Band. Everyone
changes out of their performance attire and loads instruments and
performance wear onto the motor coach. The group will re-enter
the park at the Toontown Gate
3045 S. Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-359-7200 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
Friday, March 22, 2013 – Performance Day! – (cont.)
After watching the fireworks at the park closing the group meets at
the designated location and boards the motor coaches to return to
the hotel
Everyone in their rooms
Lights out!!
Saturday, March 23, 2013
Wake up call
Breakfast at the hotel
The group gathers in the hotel lobby to walk to K nott’s Berry
Farm
Arrive and spend the day at K nott’s Berry Farm . A designated
meeting place and time will be reviewed prior to entering the park.
Lunch at the park (at own expense)
The group meets at the designated location and boards the motor
coach to return to the hotel
After freshening up the group meets in the lobby to walk to the
Medieval Times Dinner & Tournament
Everyone enjoys a dinner feast at the castle with knights, horses,
music and fun at Medieval Times Dinner & Tournament
After the show the group walks back to the hotel
Everyone in their rooms and packing begins
Lights out!!
3045 S. Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-359-7200 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
Sunday, March 24, 2013 – Clinic Day!
Wake up call
Breakfast at the hotel. Dress casually today
Everyone boards the motor coaches for transfer to Disneyland’s
California Adventure Park (Disney Performing Arts OnStage)
Arrive and spend the day at Disney’s California Adventure
Park, which is located next to Disneyland Park. A designated
meeting place and time will be reviewed prior to departing the
motor coaches
The Park Hopper pass allows everyone to travel freely between the
two parks
Lunch and Dinner at the park (at own expense)
For all workshops the following will apply
-
Comfortable and suitable clothing is required for participation.
For the safety of the participants, socks, bare feet, sandals and
flip flops are not permitted.
No food or drink may be taken into the Workshop space, except
bottled water with a cap.
No photography or video recording is permitted backstage at
any time, including inside the workshop space.
At the designated time, Orchestra and Band students and the
Director(s) will meet the Stage Manager at the Toontown Entrance
of Disneyland Park. The Stage Manager will issue a welcome and
escort the group to the motor coach to obtain instruments before
attending an Instrumental Workshop
The Thunder Ridge Band & Orchestra will enjoy their instrumental
workshop today
The clinic ends and the musicians load their instruments onto the
motor coach and reenter the park at the Toontown Gate
At the designated time, Choir students and the Director(s) will meet
the Stage Manager at the Toontown Entrance of Disneyland Park.
3045 S. Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-359-7200 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
Sunday, March 24, 2013 – Clinic Day! (cont.)
The Stage Manager will issue a welcome and escort the Choir to
attend a preselected Vocal Workshop such as Disney’s Show
Magic, Disney Sings, Sound Lesson or Show Choir Magic
Everyone enjoys their evening at the park(s)
At the designated time, Theatre students and the Director will meet
the Stage Manager at the Toontown Entrance of Disneyland Park.
The Stage Manager will issue a welcome and escort the group to
the motor coach to obtain instruments before attending a preselected Theatrical Workshop such as Performance Lab,
Improvisational Acting or Puppet Lab
The Thunder Ridge Theatre students will enjoy their acting or
improvisational workshop today
The clinic ends and the performers reenter the park at the
Toontown Gate
The group meets at a designated location at the park entrance and
boards the motor coaches for transfer back to the hotel
Everyone in their rooms
Lights out!!
Monday, March 25, 2013
Wake up call
Breakfast at the hotel
Room check and check out of the hotel. The tour manager will
expedite this process
Group loads luggage and instruments and boards the motor
coaches for Universal Studios Hollywood
Group arrives at Universal Studios Hollywood to enjoy their last
day in California. A designated meeting place and time will be
reviewed prior to departing the motor coaches
3045 S. Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-359-7200 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
Monday, March 25, 2013 (cont.)
Lunch and Dinner at the park (at own expense)
Everyone meets at a designated location and boards the motor
coaches to depart for the Los Angeles International Airport
The group departs for Colorado via Southwest Airlines
The group arrives at Denver International Airport with…
“M em ories of a Lifetim e”
3045 S. Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-359-7200 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
Trip Forms Needed
FORM
Online Trip Application – available at
TRHSmusic.com (click California)
Celestial Travel Trip Application
DCSD Overnight Field Trip Permission
Form
DCSD Health Form
Permission to carry/self-administer
Medication Form
Extended Field Trip Parent/Student
Permission, Release And Agreement
Form
Volunteer Application
Payment Submit Form
Credit Card Authorization Form
Optional Trip Insurance – highly
recommended
REQUIRED OF WHO?
Complete one for each member of
family going on trip.
Everyone going on the trip
All TRHS students going on the trip
All TRHS students going on the trip
Any student requiring medication on
the trip.
All TRHS students going on trip.
Any (non-DCSD employed) adult going
on the trip.
Submit one form every time you make a
payment either by credit card or
check. Additional forms can be
downloaded from the website.
Anyone paying by credit card. TURN
THIS FORM INTO YOUR TEACHER.
Do not send this form to travel agent.
One form per family. Please send this
form directly to Celestial Travel.
ThunderRidge High School
California Trip 2013
Rules and Guidelines
Thank you for being part of this fun and exciting trip. Below you will find rules and guidelines
we all need to follow to make this trip successful, as well as useful information to help you enjoy the
trip. All rules apply to all travelers. Please read through the materials very carefully.
Rules:
1. All Douglas County School District rules, as outlined in the Douglas County Student Code Of
Conduct, are in force on this trip. Violators will be given a district referral and disciplinary action
will be handled by the ThunderRidge administration upon return to school. In the case of
severe infractions including, but not limited to: drinking, harassment, being where you shouldn’t
be, stealing, inappropriate physical contact, etc., you will be sent home at your, and your
parents’, expense. Mr. Snell and the TRHS administration reserve the right, always, to make
this decision.
2. You are required to participate in, and be at least 10 minutes early to, everything we do. DO
NOT BE LATE, EVER! You will be charged $10.00 for each time you are late. It is
important that you put the needs of the group before your own needs, as decisions you
make could inconvenience the group as a whole.
3. You are not allowed to stay at the hotel by yourself. If you are sick, a chaperone and/or staff
member will be assigned to stay with you at the hotel.
4. You are not allowed to skip meals.
5. Room and luggage inspection may be held at any time. The student or students will be present
if an inspection is held.
6. Students of the opposite sex are not allowed in the same room. If you wish to gather, do so in
the hotel lobby, if time and/or space permits. Gathering in the hallways is not allowed. You are
to be quiet and considerate of other hotel guests.
7. You are to be in your room and stay in your room at the designated “lights out” time. If you
have a problem, contact one of the chaperones by phone. Please respect your roommates’
right to sleep. Don’t assume that they want to “stay up” and talk.
8. Vandalism is totally unacceptable. You will be held financially responsible for any damage
done to property. If there’s a problem with your room, notify your chaperone immediately.
9. Since there may be up to four people in your room, you are expected to keep your space clean
and organized.
10. Respect all chaperones and adults as you would your own parents. They are here to help you,
not discipline you. That’s the job of the TRHS staff.
11. No horseplay, loud talking/singing, etc. on the bus.
12. You are responsible for any extra room charges you incur including phone calls, room service,
etc.
13. NEVER GO ANYWHERE ALONE! You will be with at least one other person, with our
group, at all times. If you are found alone at any time, you will spend the rest of the day
with a sponsor or chaperone.
Guidelines and safety tips
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You must bring a government issued picture ID with you to the airport.
Be careful when talking to strangers. Do not give others your hotel name, room number, or cell
phone number.
Make sure to eat food and drink plenty of water. The days are long and we want you healthy.
Sunscreen, Sunscreen, Sunscreen!
You are responsible for your own belongings, including your instrument. No one will get your
stuff for you.
Be prepared for weather. We expect it to be nice, but it may change. Be prepared.
Do not over-pack. Take just what you need.
You will be limited to one piece of luggage and one carry-on. Smaller instruments i.e. flutes
and clarinets, maybe carried on the plane as well. Southwest Airlines will allow you to check
your instrument at no additional charge. If you carry-on your instrument, we recommend it.
Do not leave valuables or money in your room while you’re away. You can ask to have them
locked in the hotel safe or use the safe in your room, if provided.
You will most likely want to bring some spending money. It is difficult to determine exactly how
much to bring. We suggest a prepaid credit card that can be reloaded by your parents, if
needed. Check with your bank for the procedures for doing this. Credit cards are safer and
they can be reported if lost or stolen. Traveler’s checks are another option. We do not
recommend carrying a lot of cash.
As a representative of ThunderRidge High School, you are expected to behave in a way that
will be respectful of your self, your family, and your school.
CHAPERONE RESPONSIBILITIES
1. To be available to supervise students at all times during the trip.
2. To refrain from any activity that violates Board of Education policies and behavior
expectations (i.e. use of alcohol, illegal substances, tobacco).
3. To ensure that all participants follow the established rules and procedures set forth by the
coach/sponsor/teacher.
4. To report to the coach/sponsor/teacher any participant that is not following the rules and
procedures established for the trip.
Required from each traveler.
TRIP APPLICATION
School/Group & Trip Sponsor:
Trip Name & Dates:
ThunderRidge High School Performing Arts Department
Los Angeles: March 21 - 25, 2013
Participant’s Name:
______________________________________________________
Address
___________________________________________________________
Phone
______________________________________________________
Email
______________________________________________________
Father/Guardian’s Name:
______________________________________________________
Address
___________________________________________________________
Phone
______________________________________________________
Email
______________________________________________________
Mother/ Guardian’s Name:
______________________________________________________
Address
___________________________________________________________
Phone
______________________________________________________
Email
______________________________________________________
Health Information
Medical Insurance Company:
Policy Number:
Family Doctor:
_____________________________
Phone _______________________
_______________________________________________________________
_____________________________
Phone _______________________
We agree that the Participant can receive non-prescription medicine during the trip if the need arises. We agree that
in the event of an emergency the trip leaders may authorize emergency medical treatment for the Participant if a
parent or guardian cannot be reached.
The Participant is in good health, does not take medications, and has no special medical conditions. List exceptions
here. Attach a separate sheet if more space is necessary.
______________________________________________________________________________________________
______________________________________________________________________________________________
Travel Insurance: The Participant Accepts / Declines to purchase travel insurance (circle one). To purchase travel
insurance please fill out and submit an Insurance Application to Celestial Travel & Tours.
Trip Cost, Payments, Cancellations, & Refunds: Each participant is enrolled and shall follow the terms provided
in which a refund will be addressed in the event of cancellation.
3045 South Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-487-2929 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
We have read, fully understand and agree with the terms of this Application and the Consumer Disclosure
Notice printed on this form.
Participant’s Signature:
_______________________________________________
Father/Guardian’s Signature:
_______________________________________________
Mother/Guardian’s Signature:
_______________________________________________
Date:
_______________________________________________
CONSUMER DISCLOSURE NOTICE:
Please read the terms & conditions carefully, as your deposit payment on a trip signifies acceptance of the terms &
conditions & the general information contained in the brochure. These trips are arranged by Celestial Travel & Tours
(CT&T). It has made the travel arrangements as agent for the transportation carriers & other suppliers (SUPS) of
services connected with the tour, all of which are independent contractors. CT&T in no way owns or operates the
vehicles or facilities to be used during the trip, & does not guarantee performance by, or assume responsibility for the
acts &/or omissions of SUPS, their employees, agents, etc. All bookings are accepted subject to the conditions
imposed by SUPS & CT&T, including, but not limited to, the airline, cruise line, rail, coach, hotel, restaurants,
insurance & other companies, firms or persons concerned with the trip. CT&T will make no refund in the event of
their delay, cancellations, overbooking, strike, force majeure or for elements of the package not used by customer. If
there is a difference between CT&T conditions and those published by a SUP, the conditions of SUP shall apply.
Price quoted is per person quad (4 to a room) occupancy. CT&T reserves the right to cancel a trip, change the
itinerary or adjust rates whenever in its sole judgment conditions warrant, or if CT&T deems it necessary for your
comfort, convenience or safety. CT&T reserves the right to correct an error in the advertised price prior to your
departure. Trips outside the USA require a valid U.S. passport or other acceptable forms of citizenship proof. You
are responsible for, & release CT&T from passport, visa, vaccination requirements & safety conditions in travel
destinations. CT&T strongly recommends you purchase appropriate travel/medical/baggage/cancellation insurance
for the trip, which is available from CT&T. For medical info, call Public Health at 301-443-2403, & for travel
advisories US State Dept. at 202-647-5225, www.state.gov. A contract is made when your reservation & payment are
accepted by CT&T in its home office in Colorado & any disputes shall be governed by Colorado law & are subject to
exclusive jurisdiction and venue in court at Denver, Colorado. In calculating the cost of your trip, CT&T has relied
on your consent to these terms & in the absence of this release, the trip cost would have been higher. The Participant
and his/her Parents/Guardians hereby agree to indemnify CT&T, its officers and employees, and hold them harmless
from damages and costs resulting from claims that are presented notwithstanding this Consumer Disclosure Notice.
CODE OF CONDUCT: All tour members shall observe reasonable rules of safety and conduct as directed by the
trip leader, aided by teacher(s) chaperones and the tour escort, who has absolute authority to expel any tour
participant whose actions or behavior are considered detrimental to the group’s welfare. The trip leader, teacher(s),
Celestial Travel & Tours and its employees and agents are released from any liability to any expelled participant for
such expulsion. No refunds shall be made, and the parents/guardians agree to accept a collect call and pay the cost
to return the participant home via commercial transportation.
3045 South Parker Road, Suite 201, Aurora, CO 80014
303-773-1224 1-800-487-2929 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
TRHS STUDENTS ONLY
DOUGLAS COUNTY SCHOOL DISTRICT
OVERNIGHT FIELD TRIP PERMISSION FORM
Parent/Guardian of: ___________________________________________ Please return by: October 15, 2012
Trip to: Southern California
Date(s): March 21-25, 2013
Fee: See pmnt. schedule
Comments: _________________________________________________________________________________________
Because this activity will take place away from your child’s school, there are some special considerations and procedures which apply. We
have outlined these below:
Your child’s participation in this special activity is voluntary. Your written consent at the bottom of this form is necessary for your
child to participate.
Participation in activities away from school may potentially involve risks and responsibilities for you and your child that are beyond
the scope of those normally associated with traditional school functions under our supervision. These may include, for example,
personal injury or damage to personal property. We encourage you to inquire in advance concerning the nature and details of each
field trip and of any potential risks which will be assumed through participation. By signing below, you acknowledge that you have
made yourself aware of any potential risk associated with the field trip and that you voluntarily and knowingly assume all such risk.
The School District’s responsibility for injuries to students, or damage to their property in connection with these activities is defined
by Colorado law. Generally, the District has immunity from most claims, such as those resulting from the general supervision of
students.
The School District does not have any medical/dental/hospitalization insurance covering students for injuries incurred at school or
while on field trips. If you have not already done so you should investigate and must obtain medical insurance coverage for your
child.
If your child fails to abide by District rules of conduct and teacher instructions during the trip, it may become necessary to discontinue
his/her participation in the activity. In that case, you may be responsible for picking up your child immediately.
I hereby give my permission for my student to attend the above referenced field-trip. I hereby release and hold harmless the District,
it’s director, Board Members, officers, agents, employees, teachers and authorized volunteers from any and all liability, liens, claims,
demands, actions or cases of action, whatsoever arising from my student’s participation in the above reference field trip.
Parent/Guardian Signature _________________________________________ Date ____________________________
MEDICAL EMERGENCY/CONSENT FOR FIELD TRIP
I, _________________________________, being the parent or legal guardian of _________________________, give my consent for
emergency medical and surgical treatment in a licensed medical facility by a licensed physician should my child’s condition require it
in my absence. I understand that in such a case, reasonable attempts would first be made to contact me, time and conditions
permitting.
I confirm to the Douglas County School District that my child is in good health and that his/her participation does not pose a hazard to
his/her health or that of participating students.
As long as the medical or surgical treatment considered necessary in the situation is in accordance with generally accepted standards
of medical practice for the particular type of injury or illness involved, I impose no specific prohibitions regarding treatment unless
stated here:
______________________________________________________________________________________________________
My student has the following medical condition(s), which may require emergency care (include allergies):
___________________________________________________________________________________________________________
Signature of Parent or Guardian__________________________________________________Date____________________________
EMERGENCY CONTACTS FOR DAY(S) OF FIELD TRIP
Mother/Guardian _______________________________________ Work # _______________________ Home # ________________
Mother/Guardian Cell #_____________________________
Father/Guardian Cell # ______________________________
Father/Guardian ________________________________________ Work # _______________________ Home # ________________
Revised and reviewed by C&E 04/06. AO
EVERYBODY
OVERNIGHT FIELD TRIP HEALTH FORM
High School
Douglas County School District Re. 1
STUDENT INFO:
Student’s Name:_______________________________________Birthdate:_________________
Parent’s Name(s):____________________________________Home Phone:________________
Emergency Contact Name:_____________________________ Phone_____________________
(if parents cannot be reached)
The health information and medication information will be shared with school personnel and overnight field trip staff
as necessary to provide for your child’s safety and well-being.
HEALTH INFO:
Does your child have: (circle & specify all that apply)
Allergies?
NO
YES
Specify: Bee/Wasp Stings
Peanuts/Nuts
Other ______________________
Asthma?
NO
YES
Specify: Inhaler
Nebulizer
Other________________________
Convulsions/Seizures? NO
YES
Specify: Type_______________________________
Diabetes?
NO
YES
Specify: Insulin
Monitored Glucose Levels
Dietary modifications: food allergies or intolerance (including milk)? NO
YES
Specify: Type_______________________________
Heart Problems?
NO
YES
Specify: Type_______________________________
Other? NO
YES
Specify: Type_______________________________
Physical Limitations? NO
YES
Specify: Type_______________________________ Special equipment? ___________
Does your child require a bottom bunk for sleep walking, bed wetting, seizures, restlessness, etc.?
NO YES
Specify: Type_______________________________
Does your child take any medications? NO
YES
Specify: Type_______________________________
***Please note: ALL medications for field trip must comply with district medication policy. See
overnight field trip medication information sheet for specifics.
If your child has a condition that requires significant modifications during this overnight activity, please contact your
school nurse through your school’s main office.
HIGH SCHOOL
District Policy and State Law regulates:
•
Students in grades 9-12 may carry and self administer their own medications.
•
All medications must be in a pharmacy labeled container or the original packaging. (No baggies or
unlabeled bottles allowed.)
These guidelines are very important in order to guard your child’s safety and well-being during an overnight field trip.
Thank you so much for your careful attention to these important matters.
Health Services, Douglas County School District, Re.1
(3/04)
TRHS STUDENTS ONLY
Superintendent File: JLCD-E-3
HEALTH SERVICES
Douglas County School District Re.1
PERMISSION TO CARRY/SELF-ADMINISTER MEDICATION
STUDENT NAME
DATE
SCHOOL
DOB
MEDICATION
DOSAGE
Route of Administration
Time/Frequency
Purpose of Medication
Through my consultation with the above-named student’s parent(s)/guardian(s), as well as my own assessment of
the student (“Student”), I have determined that the Student is able to identify his/her correct medication,
demonstrate correct self-administration of the above-listed medication (“Medication”), and has knowledge of the
required dosage and timing/frequency of use of the Medication. The Student has knowledge of his/her condition
and is sufficiently responsible and able to properly carry and self-administer the Medication during the school
day. The Student has been instructed in the purpose, appropriate method, and frequency of use of the Medication
and is capable of self-administering the Medication. A new form must be completed for all medication changes.
(Physician Signature)
(Date)
(Physician’s Printed Name)
(Physician’s Telephone Number)
It is understood that the Medication will be self-administered solely at the request of, and as an accommodation
to, the undersigned parent(s) or guardian(s). The undersigned parent(s) or guardian(s) hereby agree(s) to release
the Douglas County School District Re. 1 and its personnel from any and all claim(s) which they now have or
may hereafter have arising relating to an act or omission of the Student’s use of the Medication.
(Parent or Guardian Signature)
(Date)
For students diagnosed with asthma, anaphylaxis, severe allergies, and/or other related life-threatening
conditions:
The School Nurse and the above-referenced Physician have collaborated to formulate a health care
management plan which is attached to this form.
The School Nurse, the above-referenced Physician and the Student have entered into a Permission to
Carry/Self Administer Medication Contract which is attached to this form.
Corresponding District policy JLCD is located at: http://www1dcsdk12/ResourceLibrary/JLCD.pdf
Adopted:
Revised:
Cross Ref.:
Legal Refs.:
October 1, 1991
April 4, 2006, to conform to current law; December 8, 2005; May 16, 2006
JLCD
C.R.S. 22-1-119
Douglas County School District Re. 1, Castle Rock, Colorado
Page 1 of 1
TRHS STUDENTS ONLY
DOUGLAS COUNTY SCHOOL DISTRICT EXTENDED FIELD TRIP
PARENT/STUDENT PERMISSION, RELEASE AND AGREEMENT FORM
I give my permission for _________________________________________________________ to
travel from __________________________________ to _____________________________ on
____________________________________ with __________________________________
We acknowledge having read and agree to abide by the Douglas County School District’s Code of
Conduct document. The student also agrees to follow all rules established by the teacher, coach and
supervisors on the trip, including, without limitations, rules related to curfew, staying with the group,
advising of whereabouts and rules related to behavior. Any violation of the school and/or District
Policies or of rules set by the teacher, coach and supervisors will result in the appropriate disciplinary
action up to and including sending the student home immediately at the expense of the parent and/or
student. Further, any violation of school and/or District Policy and/or rules set by the teacher, coach
and supervisors will result in the appropriate consequences, up to and including
suspension/expulsion, upon return to school. Suspension or prohibition from participation in
athletics, activities, and senior activities (including graduation ceremony) may also be consequences
imposed for behavioral violations. We agree to abide by the above as a condition of participation in
this extended field trip.
We acknowledge and agree that the student’s participation in this special activity is entirely
voluntary. Your written consent at the bottom of this form is necessary for your student to
participate.
By deciding to participate in the Extended Field Trip, the undersigned parent(s)/guardian(s) and
student expressly acknowledge that such participation in activities away from school may potentially
involve risks and responsibilities for you and your student that are impossible to predict and which
are beyond the scope of those normally associated with traditional school functions under our
supervision on School District property. These may include, without limitation, personal injury,
illness, death and loss of or damage to personal property. Since September 11, 2001, the risks also
involve the potential for actual or threatened terrorist acts.
Such acts involve risks which may include, without limitation, risks of personal injury, illness, death
and the loss of or damage to personal property. The risks also include that the trip may be canceled,
altered or terminated early because of actual or threatened terrorist acts. In such cases, fees and
expenses associated with the trip may not be refunded depending upon the policies of the trip
organizing company and individual travel, accommodation and activity providers. Trip cancellation
insurance is recommended; however, to date, no insurance has been located which will cover
cancellations based upon threatened or actual terrorist acts.
By signing below, the student and parent(s)/guardian(s) agree to exempt the School District and its
employees and authorized volunteers from any and all liability associated in any way whatsoever
with the extended field trip unless the School District would otherwise be liable under Colorado law.
The School District reserves the right to cancel the program due to insufficient participation or to
other circumstances. Where the program is canceled, all monies may be refunded, with the exception
of application fees as specified by the sponsoring agency. However, as set forth above, if the trip is
canceled based on outside circumstances or events, including, without limitation, government
advisories regarding travel, actual or threatened terrorist acts, and other circumstances which could
affect the health, safety or welfare of participants, monies may or may not be refunded, depending on
the policies of the trip organizing company, travel, accommodation and activity providers.
The undersigned as the responsible parent/guardian, agrees to inform the sponsoring teacher/coach of
any history of mental, physical, emotional or behavioral issues of the student that could affect the
general welfare of the student and/or the group.
We have thoroughly read and understand the statement of conditions stated herein and agree to the
terms of the agreement, as noted by our signatures as follows:
Parent _____________________________________________ Date ___________________
Student ____________________________________________ Date ___________________
G:\\WPF\\dcsd\\Agmnt\\extended trip form AO
ALL ADULTS, NON-DCSD EMPLOYEES
Douglas County School District
VOLUNTEER APPLICATION
2012-2013
Personal Information
Full Name: Last, First, MI
Date of Birth
Social Security Number
Driver’s License/State ID Number
(Provide a photocopy)
Current Physical Address*
Current Telephone Number
Email Address
* If you have lived outside of Colorado within the last 10 years, list town, county and state and the dates you resided there:
Placement Information
School/ClassroomVolunteer CoachElementary Enrichment
(MS or HS Athletics)(Before/After School Programs)
Overnight Chaperone/Driver: Date of Overnight Trip:
(Must send copy of reference paperwork to Risk Management for background check).
School Requested
Contact Person at School
School Contact Email
School/Classroom Experience
For the best possible placement, please answer the following questions on the back of this page:
1. What experience have you had working with children?
2. Do you have any special skills, qualifications or capabilites that would help us place you?
3. What type of volunteer work are you most interested in?
Douglas County School District
VOLUNTEER APPLICATION 2012-13
Work Experience
Current or Most Recent PositionOrganization
SupervisiorPhoneEmployment Dates (Mo/Yr - Mo/Yr)
Specific Responsibilities
Reason for leaving (if applicable)
References
Please list three people who you have known in a work and/or volunteer capacity or on a personal level:
Name Work/Home/Cell Phone
Relationship
Name Work/Home/Cell Phone
Relationship
Name Work/Home/Cell Phone
Relationship
Certification of Legal Information
The following information is asked of all persons volunteering within the Douglas County School District RE-1, in order to insure
the safety of our students, staff, and facilities.
1. Have you ever been charged or investigated for any sexually based crime? Yes
No
2. Have you ever been charged or investigated for any allegation of abuse, assault or harassment
involving another person, including children? Yes
No
Yes
No
3. Has any court ever imposed any of the following conditions based upon your behavior or conduct,
for or at any period of time, in connection with a crime (other than a minor traffic offense)?
a. Deferred sentence or deferred prosecution? b. Filed or dismissed any proceedings?YesNo
c. Required you to pay a fine or attend any sort of mandated therapy, classes, etc.? Yes
No
4. Have you ever been charged or investigated for any alcohol or drug related offense including
motor vehicle or traffic related offenses as such? Yes
No
Douglas County School District
VOLUNTEER APPLICATION 2012-13
Certification of Legal Information
If you answered yes to any of the preceding questions, in the area below please provide a full detail including with respect to the
court actions; the date and location of offense, what offense or infraction this was regarding, law enforcement agency and case
number, trial or court number assigned to this action and the disposition of each specific case.
Refusal to provide authorization for criminal records and reference checks or providing false or misleading information to include
failing to disclose information on this application shall constitute reason to deny the application or to terminate service as a volunteer
within the Douglas County School District RE-1.
PLEASE READ CAREFULLY and initial where indicated:
1. I understand that the Douglas County School District RE-1 (“district”) can and may complete a background check to include
criminal, motor vehicle (if applicable), and personal reference checks on all volunteers who work in schools and who have contact
with students and staff. I understand that the district can, at any time, complete these checks. I authorize persons and entities
contacted by the District in connection with this application to provide information about me. I expressly waive in connection
with any request for or provision of any information, claims, including without limitation; defamation, distress, invasion of privacy,
or interference with contractual relations that I might otherwise have against the district, its agents, and officials or against any
provider of any information. I understand that if I am approved as a volunteer, that I will be required to adhere to and possibly sign
any and all volunteer agreement(s), and adhere to all said agreements, district policies, and all applicable laws. I further understand
that the district reserves the right and discretion to deny my application and may suspend, restrict, and/or terminate my status and
service as a volunteer at any time. (Applicant Initial Here ________ )
2. As a volunteer with the Douglas County School District RE-1 (“district”), I have been authorized by the Principal or Principal’s designee,
or other district level authority to act as a school official subject to the direction and control of the district and school’s administration
and teachers. I understand and agree that failing to maintain the confidentiality of all student education records and information of
which I am given access may disqualify me from further service as a volunteer in the district.
(Applicant Initial Here ________ )
3. As a volunteer I understand that if approved to work within any school or site or having any access and contact to students
and staff that if I am the subject of an investigation or charged with any violation of any law, excluding minor traffic offenses but
including any and all offenses of a drug or alcohol related matter, that I am obligated to notify the Principal of any and all school(s)
or site(s) I am volunteering in. (Applicant Initial Here ________ )
By initialing all sections above and signing below, I affirm that I have read and understand all the information included in this
document, that all information provided is accurate and true information, and that I agree to abide by all sections and conditions
listed in this document.
Applicant Print NameSignatureDate
SUBMIT WITH EVERY PAYMENT
TRHS California Trip
Payment Submit Form
Payment will only be accepted with this form
Please staple payment to this form
PRINT NEATLY
Date _________________________
Student’s Last Name _____________________________ First Name _______________________________
Student ID# ___________________________________
In addition to the student named above, please list all family travelers this payment applies to:
Last name
First
Relationship to student
__________________________________
_______________________
________________________
__________________________________
_______________________
________________________
__________________________________
_______________________
________________________
__________________________________
_______________________
________________________
__________________________________
_______________________
________________________
Payment Amount $_________.___
Check # _____________ Make checks payable to GBBC
Check here if payment is by credit card
(Attach Celestial Travel Credit Card form)
*Please make separate payments for each TRHS student sibling. For example: if two TRHS students are brother
and sister, fill out separate forms and make separate payments for each. Add additional family members to only
one of the student’s account. Make sure it’s the same account each time.
Make Additional copies as needed
This form is available for download at: www.trhsmusic.com - click “California Trip”
USE THIS FORM
WHEN PAYING
BY CREDIT CARD
13 - (LAX)
ThunderRidge High School
Performing Arts Dept
CREDIT CARD AUTHORIZATION
I am a client of Celestial Travel &Tours. I hereby appoint the owner, manager, and employees of
Celestial Travel &Tours to be my attorney-in-fact for the purpose of signing my documents
necessary to purchase and issue airline tickets and/or ground packages and to charge these
purchases to my credit card.
TYPE OF CARD
____________________________________
NAME ON CARD
____________________________________
ACCT #
____________________________________
EXP. DATE
____________________________________
AMT. AUTHORIZED ____________________________________
I authorize any of my attorney-in-fact to sign credit card authorizations on my behalf, and intend
such signature to bind me the same as if I personally signed, for purchase of airline tickets and/or
ground packages. I agree that I will pay for all such purchases and will not hold Celestial Travel &
Tours responsible for any of its actions pursuant to this power of attorney. This Limited Power of
Attorney shall remain in full force and effect until terminated by me in writing, such termination to
be effective only with respect to ticket and/or ground package purchases occurring after the time
that the written termination is delivered to Celestial Travel &Tours.
___________________________________________________
Signature
________________
Date
___________________________________________________
Printed Name
______________________________________________________________________________
Street Address
______________________________________________________________________________
City and State
Zip
______________________________________________________________________________
Cell Phone
Business Phone
Home Phone
______________________________________________________________________________
*Participating Student(s) Full Name(s) as printed on their identification (CDL/Permit/Student ID)
______________________________________________________________________________
*Person(s) Participating (other than student)
Relationship to student
PLEASE TYPE OR PRINT ALL INFORMATION CLEARLY
NOTE: Please submit completed form to the trip accounting representative with school.
Celestial Travel & Tours.
3045 S. Parker Rd., Ste. 201, Aurora, CO 80014
303-773-1224 1-800-487-2929 Fax: 720-248-3718
E-mail: [email protected] www.celestialtravel.net
Do not send directly to