Slide 2 Co-op Forms and Requirements This is how things are done
at L.W.H.S. Slide 3 MONDAY MEETING Slide 4 Monday Meeting is
Mandatory!!!!!! If you do not come to Monday Meeting and you are at
school you will be turned in as skipping my class!!! Monday meeting
is the only time that I will be able to tell you important
information! You MUST attend! Skipping my class is just like
skipping any other class!! BE THERE!!! Slide 5 Pay Stubs and
Paychecks Slide 6 Pay Stubs Pay stubs will be collected every
month!! SAVE THEM!!! If you dont get paid with a paycheck and a
paystub attached, you probably do not have a job that Marion County
will accept as a real job!! SEE ME!!!! You MUST have Federal Taxes
and Social Security taken out of you Paycheck before it is a real
job! Slide 7 Paychecks You must be paid with a Paycheck! If you
dont, SEE ME!!!! You must have taxes and Social Security taken out!
YES, Ive said that twice!! If you dont have a REAL job, you must
get another job or drop the class!! YES, I SAID DROP THE CLASS!!!!!
Slide 8 Co-op Fact Sheet This form tells the Coordinator some of
the basic facts about the student. It must be filled in correctly
and legibly with INK !!! No forms will be accepted in pencil or
written illegibly. Slide 9 Transportation Form Slide 10 This form
is an agreement between Marion County Schools and your parents or
guardian. It gives you permission to drive from campus to your
O.J.T. location It also states that you agree to not ride with, or
transport OTHER work program students. Slide 11 OVERNIGHT
OUT-OF-STATE OFF-CAMPUS SCHOOL ACTIVITY OFF CAMPUS PARENT CONSENT /
LIABILITY WAIVER / MEDICAL RELEASE Student:
_________________________________________Student ID#:
___________________ School: _ LAKE WEIR HIGH_______
Club/Group/Class: __ C.D.E. CO-OP CLASS ____________Supervising
Faculty Member: _ MR. TERRY BRUNSON __________________ Activity: __
O.J.T. / VOCATIONAL TRAINING ___________Location:
________________________________________________________
_____________________________________________________________________________________________________________________
Date & Time of Departure: DAILY AT O.J.T RELEASE TIME Date
& Time of Return: WILL NOT RETURN WITHOUT PERMISSION _______
Method of transportation: q Private Car SWIMMING WILL NOT BE
PERMITTED. MEDICAL INFORMATION Date of Birth: ______________Ht:
_______ Wt: _______ Date of your childs last tetanus shot:
____________ Does your child have any of the following conditions?
Epilepsy / Seizures Yes No Motion Sickness Yes NoDiabetes Yes qNo
Hemophilia / Bleeding Disorders Yes NoAny Medication Yes NoAsthma /
Wheezing qYes qNo Heart Disease Yes No Muscular / Skeletal Problems
Yes NoAny other condition which might possibly require treatment
during the trip? q Yes No If yes, please specify:
___________________________________________________________________________________________________________________
Is your child currently being treated for any illness?q Yesq No If
yes, please specify:
_______________________________________________________ List any
allergies to: Medicines ___________________Insects
____________________Foods _____________________Other
________________________ Are there any foods your child cannot eat?
qYes qNoIf yes, please specify what foods?
_________________________________________________ PARENT CONSENT /
LIABILITY WAIVER / MEDICAL RELEASE !I/We hereby give permission for
my child to accompany employees of the Marion County School Board,
acting as chaperones, to __________________________ for the days
indicated above. I/We will not hold the Marion County School Board
nor their agents or employees accompanying the group responsible
for any accident or injury to my child except as caused by the
negligence of the School Board, its employees and agents. !In the
event my child causes any property damage or personal injury,
whether individually or in concert with other persons or entities,
I/We agree to indemnify and hold harmless the Marion County School
Board, its agents and employees. !I/We have read all the
information in regards to this trip. I am aware of guidelines of
said trip and the number of chaperones which will accompany my
child. !I/We hereby grant permission to the attending physician or
his consulting physicians, to render to my son/daughter any
emergency treatment, medical or surgical care that might be deemed
necessary to the health and well-being of said child. Also, when
necessary for the administering of such care, I grant permission
for hospitalization at an accredited hospital. !I/We assume full
responsibility and liability for any and all expenses, damage,
accident, illness, injury or medical expense of and to my/our child
or our property resulting from such participation. I/We attest and
affirm that the participant has no limitation that should prevent
participation in the activity and I/we have not been advised or
informed by anyone to the contrary. ! I/We further agree to inform
the appropriate school official(s) should my/our childs physical
condition change in any way and any time so as to affect his/her
participation in the activity herein named. My Student has medical
insurance: q Yes q NoInsurance Co: ______________________Policy #
____________________
_____________________________________________________
____________________________________ Home Telephone# Work
Telephone#Pager / Cell phone#Emergency Telephone#
_________________________________________________________________________________________________________
Parent Signature / DateHome Address / City / Zip Equal Opportunity
Schools / Drug Free Workplace Save-A-Friend / 1-877-7Friend RMD102
New Date 02/03 Slide 12 OVERNIGHT OUT-OF-STATE OFF-CAMPUS SCHOOL
ACTIVITY OFF CAMPUS PARENT CONSENT / LIABILITY WAIVER / MEDICAL
RELEASE Student: _________________________________________Student
ID#: ___________________ School: _ LAKE WEIR HIGH_______
Club/Group/Class: __ C.D.E. CO-OP CLASS ____________Supervising
Faculty Member: _ MR. TERRY BRUNSON __________________ Activity: __
O.J.T. / VOCATIONAL TRAINING ___________Location:
________________________________________________________
_____________________________________________________________________________________________________________________
Date & Time of Departure: DAILY AT O.J.T RELEASE TIME Date
& Time of Return: WILL NOT RETURN WITHOUT PERMISSION _______
Method of transportation: q Private Car SWIMMING WILL NOT BE
PERMITTED. MEDICAL INFORMATION Date of Birth: ______________Ht:
_______ Wt: _______ Date of your childs last tetanus shot:
____________ Does your child have any of the following conditions?
Epilepsy / Seizures Yes No Motion Sickness Yes NoDiabetes Yes qNo
Hemophilia / Bleeding Disorders Yes NoAny Medication Yes NoAsthma /
Wheezing qYes qNo Heart Disease Yes No Muscular / Skeletal Problems
Yes NoAny other condition which might possibly require treatment
during the trip? q Yes No If yes, please specify:
___________________________________________________________________________________________________________________
Is your child currently being treated for any illness?q Yesq No If
yes, please specify:
_______________________________________________________ List any
allergies to: Medicines ___________________Insects
____________________Foods _____________________Other
________________________ Are there any foods your child cannot eat?
qYes qNoIf yes, please specify what foods?
_________________________________________________ PARENT CONSENT /
LIABILITY WAIVER / MEDICAL RELEASE !I/We hereby give permission for
my child to accompany employees of the Marion County School Board,
acting as chaperones, to __________________________ for the days
indicated above. I/We will not hold the Marion County School Board
nor their agents or employees accompanying the group responsible
for any accident or injury to my child except as caused by the
negligence of the School Board, its employees and agents. !In the
event my child causes any property damage or personal injury,
whether individually or in concert with other persons or entities,
I/We agree to indemnify and hold harmless the Marion County School
Board, its agents and employees. !I/We have read all the
information in regards to this trip. I am aware of guidelines of
said trip and the number of chaperones which will accompany my
child. !I/We hereby grant permission to the attending physician or
his consulting physicians, to render to my son/daughter any
emergency treatment, medical or surgical care that might be deemed
necessary to the health and well-being of said child. Also, when
necessary for the administering of such care, I grant permission
for hospitalization at an accredited hospital. !I/We assume full
responsibility and liability for any and all expenses, damage,
accident, illness, injury or medical expense of and to my/our child
or our property resulting from such participation. I/We attest and
affirm that the participant has no limitation that should prevent
participation in the activity and I/we have not been advised or
informed by anyone to the contrary. ! I/We further agree to inform
the appropriate school official(s) should my/our childs physical
condition change in any way and any time so as to affect his/her
participation in the activity herein named. My Student has medical
insurance: q Yes q NoInsurance Co: ______________________Policy #
____________________
_____________________________________________________
____________________________________ Home Telephone# Work
Telephone#Pager / Cell phone# Emergency Telephone#
_____________________________________
____________________________________________________________________
Parent Signature / DateHome Address / City / Zip Equal Opportunity
Schools / Drug Free Workplace Save-A-Friend / 1-877-7Friend RMD102
New Date 02/03 Slide 13 Parent-Student Agreement This form list the
rules and expectations that the L.W.H.S. Cooperative Education
Student must achieve to be a success in the program and on the job.
Slide 14 Slide 15 Employers Agreement This agreement is between The
Marion County School Board and your employer. Among other things,
it spells out that the coordinator( thats Mr. Brunson) has the
authority to keep you in school, to change your work schedule and
even to deny you the right to work at a certain job. If this
happens, you have agreed to abide by my judgments, or drop the
class. Slide 16 Slide 17 Student Training Plan These are things
that your employer will want you to learn on the job (O.J.T.) These
things are found on your BLUE CARD Slide 18 Slide 19 Blue Card
