Rio Norte Junior High School Music Department Rio Norte Drive, Valencia, CA PH X 1505

Transcription

1 Festival and Disneyland Tour PARTICIPANT COMMITMENT CONTRACT I,, hereby commit and guarantee that (Parent or legal guardian printed name) will travel with the Rio Norte, (Student printed name) to participate in the music festival and Disneyland park outing from April 13-15, I understand that participating in this event is optional and not part of the regular classroom experience. This event will require the students to be in the Anaheim, CA area for those two days. The goal is to raise over $30,000 for everyone to participate in the festival trip. This amount equals either $335 per student if the student opts to stay in a 5 student room or $321 per student if the student opts to stay in a 6 student room. That amount will include all travel costs, lodging, meals, entrance to Disneyland and all festival expenses. Parents can offset the fund-raised portions with direct donations on their child s behalf. No amounts raised as part of fund raisers will be directly refundable at any point. No refunds or cancellations are available after March 16 th, The Rio Norte will provide and administer fund raising opportunities to enable each member to raise the cost per student. Those fund-raisers include, but are not limited to; Butter Braids ($5 from each braid goes towards goal) October event Krispy Kreme ($6 from each dozen pre-order goes towards goal) August & March events See s Candy (amount varies from $2-$3.50) January/February event Sponsorships (ongoing) Disneyland Festival April 13-15, 2018 Payment Plan Please make ALL checks payable to Rio Norte ASB. Due (or fundraised) by October 13 th - $50 (non-refundable fee) Due (or fundraised) by December 8 th - $100 Due (or fundraised) by February 2 nd - $100 Final Payment Due (or fundraised) by March 16 th - $85 (or remaining balance) Total: $335 (5 students per room) or $321 (6 students per room) Signature Date

2 I, hereby give my permission for my son or daughter to travel with the Rio Norte Music Department to Anaheim, California, from April 13 th to April 15 th, I understand that travel will be via school bus for the duration of this festival and outing. I understand that, pursuant to the rules of behavior attached hereto, misbehavior by my son or daughter may result in him/her being sent home from Anaheim and that I would be liable for transporting him or her from that city including any additional travel costs. In addition to those guidelines of behavior, I specifically prohibit the behaviors and/or activities listed below: (chaperones will attempt to enforce those restrictions but hope that parents will determine and communicate consequences for students going against their wishes separately from the Rio Norte consequences.) NOTE TO PARENT OR GUARDIAN: Section of the California Education Code states in part: All persons making the field trip shall be deemed to have waived all claims against the district or the State of California for injury, accident, illness, or death occurring during or by reason of the field trip excursion. Activities prohibited by parents or guardians: Phone numbers where I may be reached in case of emergency: Home phone: Work phone: Spouse s name Work phone: Alternate emergency contact name phone: Signature Date:

3 STUDENT BEHAVIOR GUIDELINES The guidelines below are intended as a list of specific rules to follow. However, they cannot cover every possibility, as always, all are expected to behave in ways that would only enhance the reputation of our ensembles, our school and our community. Normal standards of courtesy, honesty, and good will should prevail at all times. 1. Be supportive and encouraging to other groups and courteous to all whom you encounter. Be polite and encouraging to all those traveling with us. 2. Curfew for all students will be 10:00 pm. Lights out/sleep/silent time will be 11:00 pm. No student may be outside his/her room after curfew for any reason. 3. When traveling about, students must travel in groups of at least 3 people. All hotel, festival, and other facility rules will be strictly adhered to. Any disturbance of other hotel or festival guests will result in disciplinary action. Financial responsibility for any broken or damaged items in rooms will fall upon the party responsible for the damage. If no individual can be identified, costs will be shared by all assigned to the room where the damage occurred. 4. Do not be even one second late for any scheduled bus boarding or other scheduled activity time. 5. No boys are permitted in any room assigned to girls at any time and vice versa. No outsiders (people who are not members of our group) are allowed in any of our rooms at any time! You are encouraged, to keep everyone out of your room except those who are assigned to that room. 6. Use or possession of any tobacco products or any other drugs or alcohol and possession of any weapons as identified by school district policy are absolutely prohibited at all times. Since it will be impossible for the directors to see everything that goes on, chaperones word will be accepted as fact, and their decisions will be final! Any student failing to comply with any of the above will be confined to the supervision of a chaperone or sent home at their parents expense. SCHOOL RULES ARE IN EFFECT AT ALL TIMES. IF ANY STUDENT FAILS TO COMPLY WITH RULE 4, 5 OR 6, OR BREAKS ANY LAW INCLUDING FIGHTING (ASSAULT), THAT STUDENT S PARENTS WILL BE REQUIRED TO PROVIDE TRANSPORTATION FOR THE IMMEDIATE RETURN HOME OF THE STUDENT. SUCH STUDENTS WILL BE EXCLUDED FROM ALL OTHER ACTIVITIES NOT SPECIFICALLY RELATED TO CLASSROOM CURRICULUM FOR THE REST OF THE YEAR.

4 28771 Rio Norte Drive, Valencia, CA PH X 1505 STUDENT PARTICIPANT CONTRACT I, Hereby promise that, at all times during our trip to Disneyland, in the Anaheim area, (April 13 to April 15, 2018) I will do my best to represent my ensemble, my school, my family, and my community in a musically artistic and personally honorable way. I will obey all laws of my country and the state of California as well as all the rules of behavior set forth by our own Rio Norte organization. I will maintain the highest standards of integrity, decency, courtesy, morality, and musicality and will encourage others to do the same. I promise that I will assume personal responsibility for all of the above and that I will hold to my promises because of my own sense of propriety and regardless of any risk of being caught doing anything inappropriate. I promise that I will treat our chaperones, our director and advisor, and other students from our own and other schools with respect and good will, and, within the bounds set forth above, will attempt to make this tour as enjoyable and rewarding as possible for all involved. signature date

5 AUTHORIZATION TO CONSENT TO TREATMENT OF A MINOR I (we), the undersigned, parent (s) of, (Print student s name) do hereby authorize Mr. Jeffrey Gilbert, band director, as agents for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the medicine Practice Act on the Medical Staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. I also authorize any non-invasive drug testing should the band director deem it necessary. I assume full responsibility for payment for such treatment either individually and/or via insurance as is listed below: Name of employer: Insurance Company: Name of HMO: Name of Physician: Group number: Phone: Policy number: It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our afore said agent to give specific consent to any and all such diagnosis, treatment, of his/her best judgment may deem advisable. This authorization is given pursuant to the provisions of section 25.8 of the Civil Code of California and shall remain effective until June 1, 2018 The physical conditions, allergies, and/or patient history listed below should be considered by any physician when recommending treatment or formulating diagnosis: The student identified above is currently taking the following medications Parent/guardian signature(s):, Date Parent guardian printed names:, Witness signature:, Printed name Date

6 WM. S. HART UNION HIGH SCHOOL DISTRICT PARENT S OR GUARDIANS PERMISSION FOR FIELD TRIP AND AUTHORIZATION FOR MEDICAL CARE To the principal of Rio Norte Junior High School: has my permission to participate in the field trip to (Student s Name). Purpose of Trip: Disneyland Music Festival Date April 13-15, 2018 Departure Time 9:00_ AM Return Time 10:30 AM Supervisor(s) of trip: Jeffrey C Gilbert / Vicki Kaplan LUNCH ARRANGEMENTS: METHOD OF TRANSPORTATION: Student will be at school Walking _X_ School Bus / Charter bus during lunch X Student should bring sack Private Auto lunch. Other: Driver s Name (Please Print) Other: Other Information: NOTE TO PARENT / GUARDIAN: Section of the California Education Code states in part: All persons making the field trip shall be deemed to have waived all claims against the district or the State of California for injury, accident, illness, or death occurring during or by reason of the field trip or excursion. I give my permission for my student to attend this trip. I agree to direct my student to be cooperative with directions and instructions of the school district personnel in charge of the activity. (Parent s/guardian s signature) Date AUTHORIZATION FOR MEDICAL CARE Should it be necessary for my child to have medical care Student s name Date of Birth while participating in this trip, I hereby give the School district personnel permission to use their judgment in Home Address obtaining medical care and ambulance service for the child, and I give permission to the physician selected by Parent/ Guardian name (please print) the School District personnel to render medical care deemed necessary and appropriate by the physician. I Business telephone parent/guardian understand that the School district has no insurance covering such medical or hospital costs incurred by my child and therefore, any costs incurred for such treatment shall be my sole responsibility. Emergency Telephone number Authorization Signature of Parent/guardian Instructions for special medical treatment: