Camp Hanes

November 15-16, 2012 Dear Parent, The Fifth Grade Team has set our dates for our first fall field trip to Camp Hanes. Camp Hanes is a two day, one night field trip where your child will explore, through hands on activities, our science curriculum. Your child will also engage in problem solving and team building activities while enjoying the foothills of North Carolina. The team building activities unite and allow students to collaborate with students from other classes. New friendships, budding leaders, and an “I can do” attitude are results of our time together at Camp Hanes. This is a wonderful experience for your child that enriches his/her learning and self-confidence. Our goal is to have all 100 fifth graders attend Camp Hanes. Camp Expectations: Camp Hanes requires students to demonstrate exemplary behavior. This field trip is a learning experience for all students; however, we also expect our students to demonstrate exemplary SOAR behavior in this setting. Being safe, outstanding, accountable and respectful must also be demonstrated on a daily basis here at Southwest. Academic and Behavior Expectations prior to November 15-16:

• Students are expected to show their SOAR behaviors daily. • Students are expected to complete homework and classroom assignments daily. • Receiving an office referral (D-1 form) may keep a student from attending Camp Hanes.

How Much Will Camp Hanes Cost? We project that the field trip will cost approximately $75.00. Our cost will be decreased by monies collected through fund raising. A $20.00 first payment is due on November 9th, Friday to your child’s teacher. After our fall and winter fundraisers, we will notify you of the total amount due before February 28, 2013. When Will Parents Be Given More Details Regarding Camp? A Parent Meeting regarding Camp Hanes will be held October 8th at 6:30. Our chaperones meeting will be on November 8, Thursday in the media center. Attached is the required paperwork for camp. If you have any questions about Camp Hanes, chaperoning, fund raising or the payment plan, please contact your child’s teacher. The Fifth Grade Team ------------------------------------------------------------------------------------------------------------------------------- Return this portion to your child’s teacher by November 9th, Friday. We need to get a count of how many students and begin making cabin and activity group assignments. No money is due with this form. _____No, my child will not attend Camp Hanes. _____Yes, my child will attend Camp Hanes. Please sign below if your child is attending Camp Hanes and to show that you accept and understand our expectations for participation in the Camp Hanes field trip. Parent signature: Date Student signature: Date

WINSTON SALEM FORSYTH COUNTY SCHOOLS School Escuela)____________________

PERMISSION TO SECURE MEDICAL CARE Permiso para obtener Servicios Médicos

Dear Parent or Guardian: Estimados padres de familia o guardianes:

It is extremely important that the school have on file current information for emergency use

regarding your place of employment, work hours, names and telephone numbers of neighbors,

relatives, baby-sitters, and child care providers. Please make an effort to keep this information on your child’s record up-to-date. En caso de una emergencia, es muy importante que la escuela tenga

archivada la siguiente información: el lugar de su empleo, su horario de trabajo, los nombres y números

de vecinos o parientes. Por favor infórmenos de cualquier cambio de dirección o teléfonos.

In the event that your child becomes seriously ill or injured while at school, the school will take action as outlined below: Si su hijo(a) se enferma o sufre un accidente en la escuela, la escuela tomará

acción de acuerdo a lo siguiente:

1. Appropriate first aid will be administered immediately when the situation calls for it. Se le

darán los primeros auxilios si la situación así lo exige.

2. In extreme emergencies, your child will be taken immediately to the hospital emergency room

by ambulance or private vehicle and you will be contacted and advised of the situation. In most

cases, however, efforts will be made to contact you first and seek your advice concerning the

action to be taken by the school. En caso de una emergencia muy grave su hijo(a) será llevado al

servicio de emergencia del hospital en ambulancia o en carro privado. Usted será avisado de

inmediato. En la mayoría de los casos la escuela tratará de llamar a los padres primero para pedir

consejo en cuanto a la acción a tomar.

3. In the event you cannot be located, or in extreme emergencies, school officials will decide

whether immediate medical treatment is needed and will act accordingly. In order to assure

that proper medical treatment can be obtained under the conditions described above, the school

system requests that you complete the form below giving the school permission to obtain

medical treatment for your child and certifying that you will accept the financial responsibility

for payment of any ambulance, hospital and/or physicians. Si no podemos encontrar a los padres o en extrema urgencia, los oficiales de la escuela decidirán si

se necesita tratamiento médico inmediato. Para que la escuela se pueda asegurar que el tratamiento

médico se aplique según las condiciones mencionadas arriba, el sistema escolar exige que complete

la información de abajo. La forma certifica que usted autoriza a la escuela a obtener tratamiento

médico para su hijo(a).También que usted acepta la responsabilidad de pagar el costo de la

ambulancia, hospital y/o el costo de los médicos.

I, the undersigned, give permission to the Winston-Salem/Forsyth County School System and my

child’s school to act in my behalf in my absence or in emergency situations to obtain medical

treatment for my child _________________________________________________________________

I agree to accept full responsibility for the payment of all ambulance, hospital and physicians for

any services rendered.

Parent’s Signature _____________________________ Date___________Phone_________

Yo, el que firma, doy permiso al sistema escolar de Winston-Salem/Forsyth County y a la escuela de mi

hijo(a), para que puedan actuar en mi lugar en mi ausencia y en caso de emergencia para obtener

tratamiento médico para mi hijo(a) ________________________________________________________

Acepto la responsabilidad completa de pagar los servicios de ambulancia, hospital y/o médicos.

Firma del Padre/guardián ________________________ Fecha ________Teléfono_________

Medical Insurance (Seguro Médico)__________ Policy Number (número de poliza)_________

Check your preference (marque su preferencia): Baptist Hospital ____ Forsyth Hospital______

Name of nearest Relative or friend and relationship (Nombre del Pariente más cercano o amigo y

relación con su hijo(a) Phone (teléfono)

Does your child have any of the following conditions:

Telephone:

Telephone:

Grade:

Where does the child receive health care:

School:

Winston-Salem/Forsyth County Schools

Student Health History and

Emergency Medical Information

Student's Name:

Parent, Guardian, Caretaker Name: Date of Birth:

Home Telephone: Work Telephone:

Please complete this brief health history form and return it to your child's teacher or school as soon as

possible. This information is needed to care for your child in case of illness or injury and to meet your child's

health needs at school. If your child needs medication at school, an Administration of Medication Form must

be completed and returned to the teacher or school. The form can be obtained at school. Contact the school

secreatary if you need to talk with the school nurse.

The information contained on this form is confidential as provided by federal law, the Family Education Rights

and Privacy Act, FERPA, 20 USC 1232g and state law. Only those school employees with a good educational

Name of Doctor/Clinic: Date of last physical exam:

Name of Dentist: Date of last physical exam:

Alergies Yes NoIf yes, what is your child allergic to: Is medication needed at school?

Yes No

Asma Yes No If yes, when was last attack? Is medication needed at school?

Yes No

If yes, does your child need a diabetes

care plan?

Is medication needed at school?

Yes No

Is medication needed at school?

Yes No

If yes, when was last seizure?

Diabetes Yes No

Seizures Yes No

Vision Problems YesDoes your child wear glasses or contacts?

Yes No

Hearing Problems

Yes No

Does child have a hearing loss?

Yes No

Does child wear a hearing aid?

Yes No

Heart problems

Yes No

If yes, name problem: Is medication needed at school?

Yes No

Is exercise limited?

Yes No

Orthopedic Problems

Yes No

Si so, describe the problem.

Signature of parent, guardian or car taker: Date

Other Health problems. If yes, please describe:

Was your child hospittalized or did your child have major changes in health during the past year? Yes! No !