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  • Student Registration Information: April 9 April 11

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    Student Registration Information Must be completed by the participating student and his / her parent / guardian immediately following the regional competition on April 9. If not possible, complete at home and hand in during morning walkaround on April 11. Failure to do so will prevent you / your child from being registered and eligible to attend states!

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    Student Registration Information Must be completed by the participating student and his / her parent / guardian immediately following the regional competition on April 9. If not possible, complete at home and hand in during morning walkaround on April 11. Failure to do so will prevent you / your child from being registered and eligible to attend states!

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    © All Rights Reserved
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    53 vizualizări2 pagini

    Student Registration Information: April 9 April 11

    Încărcat de

    api-282286107
    Student Registration Information Must be completed by the participating student and his / her parent / guardian immediately following the regional competition on April 9. If not possible, complete at home and hand in during morning walkaround on April 11. Failure to do so will prevent you / your child from being registered and eligible to attend states!

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 2

    Student Registration

    Information
    Mustbecompletedbytheparticipatingstudentandhis/her
    parent/guardianimmediatelyfollowingtheregionalcompetitionon
    April
    9
    .Ifnotpossible,completeathomeandhandinduringmorning
    walkaroundon
    April11
    .Failuretodosowillpreventyou/yourchild
    frombeingregisteredandeligibletoattendStates!

    StudentInformation
    FirstName:________________MiddleInitial:____LastName:______________
    DateofBirth:_______________Ageasof5/10/16:________Grade:________

    Parent/GuardianInformation
    FirstandLastName(s):_______________________________________________
    HomeAddress:_____________________________________________________
    _________________________________________________________________
    HomePhoneNumber(s):__________________________________
    CellPhoneNumber(s):____________________________________
    EmailAddress(ifapplicable):________________________________

    WaiverofLiability
    Bysigningtheagreementbelow,IagreetoindemnifyandholdharmlessNationalHistoryDay,Inc.,itsaffiliateprograms,anditsstaff,
    trusteesandsponsors,foranypersonalinjuriesorpropertydamagesarisingoutofmyparticipationintheNationalHistoryDayContest.

    Parent/GuardianSignature:___________________________Date:_________

    MediaRelease
    IgiveNationalHistoryDay,Inc.,itsaffiliateprograms,anditspartnerstheunlimitedrighttousethevoiceand/orimageofmeand/ormychild
    forpublicity,and/orindocumentaries,orothereducationmaterialsandmedia.

    Parent/GuardianSignature:___________________________Date:_________

    ProjectInformation~WebsitesOnly
    WeeblyUsername:__________________________
    WeeblyPassword:__________________________

    StatementofOriginality~StudentParticipantsMustSign!
    Iaffirmthattheentrysubmittedforcompetitionwasresearchedanddevelopedduringthisschoolyear.IhavereadtheNationalHistoryDay
    rulesandpoliciesgoverningstudentbehaviorandwillconformtotheserules.Iunderstandthatviolationoftheserulesmayresultinthe
    disqualificationofmyentry.Iacceptthedecisionofthejudgesasfinal.

    Ihavereviewedandunderstandtheinformationpresentedabove,andacknowledgethatmyparticipationinNationalHistoryDayis
    conditionedonmyagreementwiththetermsandconditionsoutlinedherein.

    StudentsSignature:___________________________Date:_________

    StudentMedicalInformation~CONFIDENTIAL
    MedicalConditions(ifapplicable):_____________________________________
    _________________________________________________________________
    Allergies(ifapplicable):______________________________________________
    SpecificDiet/FoodNeeds(ifapplicable):_________________________________
    Medications(ifapplicable):___________________________________________
    ________________________________________________________________

    Note:
    IfyoulistANYmedicationsabove,youmustcompleteamedicationwaiverthroughtheschoolnurse,whichrequiresadoctorssignature,beforeMay
    9th

    Ifyoualreadyhaveoneonfilethroughthemiddleschool,youdonotneedtocompleteanother
    YourchildsmedicationmustbeprovidedtoMissTurnerbeforeMay9thintheindividualdosageenvelopesthatyourchildcanpickupfromtheschool
    nurseatyourearliestconvenienceyouwillneedoneenvelopeforeachindividualdoseofthemedicationthatmustbeadministeredbyMissTurner
    StudentsarenotallowedtocarryANYmedicationonthemitallmustbehandledthroughMissTurnerandtheschoolnurseforlegalpurposes
    ThisincludesoverthecountermedicationssuchasTylenol
    SeeMissTurnerorcalltheschoolnurse,MarciaRega,ifyouhavequestionsorconcerns
    Thisisallprotocolforallovernightfieldtripsthroughtheschooldistrict

    CellPhonePolicyWaiver
    Iunderstandthatmychildisallowedtobringhis/hercellphoneonthetripatourfamilysownrisk.Weunderstandthatstudents
    areonlypermittedtousetheirphonesforcontactwiththeirparents/guardiansatdesignatedtimesandformusic/gamesonthebus
    rideorduringdowntime.Studentsarenotpermittedtobetakingvideosorphotographsofthemselvesorotherstudentsthatwould
    inanywayreflectnegativelyontheschooldistrictforthedurationofthetriporthatmayresultindisciplinaryactionsuponour
    return.Studentsarenotpermittedtopostphotographsorvideosofotherstudentsonsocialmediaforprivacypurposes.I
    understandthatallschooldistrictandschoolwidepoliciesforcellphoneuseandetiquetteapply.Failuretorespectthese
    expectationscouldresultinmychildsreferraltotheassistantprincipalforASD/ISS/OSSuponreturnfromthetrip.

    Parent/GuardianSignature:___________________________Date:_________
    StudentsSignature:___________________________Date:_________

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