Behavior Contract. I understand the following behavior is expected of me while I am at Frost Valley:

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2 Behavior Contract I understand the following behavior is expected of me while I am at Frost Valley: 1. To cooperate with fellow students, teachers and the Frost valley staff. 2. To cooperate with and accept the responsibility for completing any work assigned to me. 3. To have good manners at all times. 4. To participate in all the activities that I am assigned. 5. To be on time for all activities and meals. 6. To respect the property of others, not to enter anyone's room without their permission and not to touch anyone's property. 7. To remain in the lodges between lights out and the morning wake up call. 8. To keep my room neat and not to mark any of the Frost Valley property. If I damage anyone else's property, I will pay for the damages. 9. To respect quiet hours in the lodge from 10:00 pm to 7:00 am, lights out is at 10:00pm. It is VERY important that I am well rested and ready each day for the full day of activities. 10. To not collect any living things (plant or animal) unless supervised by a Frost Valley Program Instructor for a specific class activity. 11. To go in the lodges alone, I must be accompanied by an adult at all times. 12. To make the trip the most interesting and rewarding by getting involved in the activities and following instructions to the best of my ability. Anyone who shows that he/she cannot live harmoniously with others, endangers his/her own safety or that of his fellow students, or cannot accept the rules and regulations, will be required to call his/her parents and will be removed from the group and asked to leave Frost Valley. I have read and understand the above information. I promise to follow these guidelines and be on my best behavior during the trip. Student's Signature Parent's or guardian's signature

3 Dietary Form Student s name Please check the appropriate box(es) and provide necessary explanations. No dietary restrictions. My child is a vegetarian. My child has the following dietary restrictions: Because of religious beliefs, my child does not eat: My child is allergic to: My child is allergic to the following in his/her food surroundings: Additional comments

4 MONTCLAIR KIMBERLEY ACADEMY REQUEST FOR MEDICATION TO BE ADMINISTERED BY SCHOOL NURSE PARENTAL/GUARDIAN REQUEST I, the parent/guardian of request that the school nurse administer the medication prescribed by my child's physician to my child at the prescribed time. Phone Number Signature of Parent Date Address PHYSICIAN'S STATEMENT In order to maintain the health of it is necessary for her/him to have the following medication during school hours. Medication Dosage & Route Times to be administered Purpose of medication List any possible side effects, which might be expected Allergies Diagnosis I authorize the school nurse to administer this medication. Phone Number Signature of Physician Date Address

5 IMPORTANT The following must be in order before the trip: Your child s physical must be up to date. If your child needs medications on the trip (for example medications that are usually given at home), please fill out the attached form. One page is needed for each medication. If your child takes more than one medication simply make more copies. Please note that you and your child s doctor must fill out this form. If it is not filled out completely, the nurse will not be able to dispense the medication. ALL MEDICATION MUST BE SENT TO THE SCHOOL BY FRIDAY, SEPTEMBER 9, PLEASE PUT MEDICATION IN A ZIPLOC BAG LABELLED WITH YOUR CHILD S NAME AND GRADE. All medication must be in the original pharmacy dispensed bottle. Simply ask your pharmacist to dispense enough for the trip in a separate bottle or empty your bottle at home into a sealed container and send enough of the medication for the trip in the pharmacy bottle. Tylenol and Advil will be available from the nurse. Inhalers and epi-pens are the only medications that students will be allowed to carry AS LONG AS YOUR MD HAS GIVEN A WRITTEN ORDER THAT STATES THAT THE STUDENT CAN SELF-MEDICATE. If your child has an epi-pen or inhaler in school in the nurses office, that epi-pen or inhaler will be sent on the trip. YOU DO NOT NEED TO GET PAPERWORK FOR THOSE MEDICATIONS FILLED OUT AGAIN!!!!! If you have any questions. Please do not hesitate to contact me at (973) OR thigh@mka.org. Toni Lee High, RN

6 FROST VALLEY YMCA CLOTHING/EQUIPMENT CHECKLIST Your child s bag/suitcase, sleeping bag and pillow should be placed in a large trash bag with first name and last name clearly written on the bag. This will protect belongings from getting wet if it rains! All jewelry and other expensive belongings (mp3 players, video games, digital cameras, etc.) or those of sentimental value should be left at home. NO Cell Phones allowed. Items strictly prohibited are: weapons including pocket knives, matches and other flammable items, and food. Required Items: Sleeping bag or bedding for a single bed Pillow Pajamas Underclothes (2 sets per day) Socks (2 sets per day) Shoes (2 pairs; sneakers a must) Pants or shorts (1 pair per day, weather appropriate) Shirts (short and long sleeve for layering) Bath towel and washcloth Toiletries (toothbrush, toothpaste, soap, shampoo, hairbrush, etc.) Bag for dirty/wet clothes Rain outerwear Hat Sweater or sweatshirt Flip-flops or sandals for shower area Water Bottle Extra garbage bag to put suitcase/bag when departing Optional Items: Flashlight Bug repellant and sun block Disposable camera Wristwatch