HUNTINGTON MIDDLE SCHOOL FIRST DAY PACKET

2013-2014 SCHOOL YEAR

Please complete and return the enclosed forms and return them to School, any time from August 12, to August 20, from 9am to 12noon daily (to receive the homeroom assignment early) or on the First Day of School – Must be in No Later Than Wednesday August 21, 2013.

Failure to return the completed forms will mean that a student cannot attend class until completed forms are received.

A. Complete, Sign and Return ALL 4 Forms: (MANDATORY)

_____ 1. Student Directory Information Form – Please review & make necessary corrections.

_____ 2. HMS Master Signature/District Acknowledgement Form (Available ON-LINE Only)

_____ 3. Emergency Health Cards: Fill out completely (Available ON-LINE Only)

_____ 4. Extra-Curricular Insurance Exemption Statement (Available ON-LINE Only)

B. Please Also Include: (Optional)

_____ 1. PTA Order Form (PTA Form Available ON-LINE Only, payable to: HMS PTA) _____ 2. San Marino Schools Foundation Donation (Form Available ON-LINE Only; payable to: SMSF) _____ 3. HMS Clothing Order Form _____ 4 . HMS Volunteer Opportunities Sign-up Form _____ 5. HMS Health Office Volunteer Form _____ 6. eScrip Fundraiser Enrollment Form _____ 7. Partnership for Awareness (payable to: PfA) _____ 8. Cafeteria Lunch Payment Form

All ON-LINE Only documents and other documents listed above are available on the district website www.smusd.us as well as Huntington Middle School website www.hehms.us. Just go to “News and Announcements” and click on “First Day Packet”.

THANK YOU FOR YOUR SUPPORT AND COOPERATION!

2013-2014 Huntington Middle School Information Sheet ID#________________ (Last Name) (First Name) (M.I.) (DOB) (Grade) (Address) Please check if new address (City) (Zip Code) (Area) Home Phone I am living with: Parent1 Guardian1 I am living with: Parent2 Guardian2 Both | Print Parent 1/Guardian 1Name Print Parent 2/Guardian 2 Name | Name of Company Occupation Name of Company Occupation | Business Phone Cell Phone Business Phone Cell Phone

E-Mail Address E-Mail Address

* IN CASE OF EMERGENCY - NOTIFY * In case of illness, accident or emergency and when unable to contact parents, permission is granted for any of the following to call for or take care of my child: (Please note: We cannot release your child to anyone unless their name is listed below. Please list names of housekeeper and anyone free and willing to pick up your child. List at least 3 contacts.) Name__________________________________________________ Phone #_____________________________ Name__________________________________________________ Phone #_____________________________ Name__________________________________________________ Phone #_____________________________ Name__________________________________________________ Phone #_____________________________ Student may not be released to ______________________________________________________________

CONSENT FOR RENDERING OF MEDICAL SERVICES

In case of illness, accident or emergency and when the school is unable to contact us, we, the undersigned parents (guardians) of: ___________________________________ date of birth _________________, a student of the San Marino Unified School District

hereby consent to the giving of any and all emergency, medical, hospital and surgical care to said student that may be deemed necessary by any physician or hospital or any official of the San Marino Unified School District without obtaining further consent.

Doctor’s Name __________________________________________________Phone#____________________________ Hospital of your choice _______________________________________________________________________________ List any pertinent health information (Allergies – Medications etc.): ___________________________________________________________________ I verify that I have read the above and filled out the above information correctly. Parent/Guardian Signature ___________________________________ Date _________________

COPY 1 – Health

2013-2014 Huntington Middle School Information Sheet ID#________________ (Last Name) (First Name) (M.I.) (DOB) (Grade) (Address) Please check if new address (City) (Zip Code) (Area) Home Phone I am living with: Parent1 Guardian1 I am living with: Parent2 Guardian2 Both | Print Parent 1/Guardian 1Name Print Parent 2/Guardian 2 Name | Name of Company Occupation Name of Company Occupation | Business Phone Cell Phone Business Phone Cell Phone

E-Mail Address E-Mail Address

* IN CASE OF EMERGENCY - NOTIFY * In case of illness, accident or emergency and when unable to contact parents, permission is granted for any of the following to call for or take care of my child: (Please note: We cannot release your child to anyone unless their name is listed below. Please list names of housekeeper and anyone free and willing to pick up your child. List at least 3 contacts.) Name__________________________________________________ Phone #_____________________________ Name__________________________________________________ Phone #_____________________________ Name__________________________________________________ Phone #_____________________________ Name__________________________________________________ Phone #_____________________________ Student may not be released to ______________________________________________________________

CONSENT FOR RENDERING OF MEDICAL SERVICES

In case of illness, accident or emergency and when the school is unable to contact us, we, the undersigned parents (guardians) of: ___________________________________ date of birth _________________, a student of the San Marino Unified School District

hereby consent to the giving of any and all emergency, medical, hospital and surgical care to said student that may be deemed necessary by any physician or hospital or any official of the San Marino Unified School District without obtaining further consent.

Doctor’s Name __________________________________________________Phone#____________________________ Hospital of your choice _______________________________________________________________________________ List any pertinent health information (Allergies – Medications etc.): ___________________________________________________________________ I verify that I have read the above and filled out the above information correctly. Parent/Guardian Signature ___________________________________ Date _________________

COPY 2 – Earthquake

San Marino Unified School District H.E. Huntington Middle School

1700 Huntington Drive, San Marino, CA 91108 A National Blue Ribbon School and A California Distinguished School

DISTRICT ACKNOWLEDGEMENT FORM AND

MASTER SIGNATURE SUMMARY 2013-2014

The following documents are found online @ http://www.hehms.us/

• ATTENDANCE: We have read (on line) and understand the Attendance Procedures information. • DISCIPLINE: We have read and discussed the Discipline Contract together (on line) and understand the

consequences of irresponsible decision making. • EXTRA CURRICULAR INSURANCE EXEMPTION STATEMENT FORM: We have read (on line)

and understood the Extra Curricular Insurance Exemption Statement Form. • SEXUAL HARASSMENT NOTIFICATION: We have read (on line) and understand the Sexual

Harassment Notification. • SNACK BREAK/LUNCH EXPECTATIONS: We have read (on line) and discussed the Snack

Break/Lunch Expectations together and understand the responsibilities of students to maintain a clean campus.

• STUDENT ACTIVITIES SHEET: We have read (on line) and understand the guidelines for the co-curricular and extra-curricular activities at Huntington Middle School.

• TECHNOLOGY: We have read (on line) the Discipline Standards regarding Technology use at Huntington Middle School.

• EMERGENCY: I have completed and SIGNED all copies OF THE INFORMATION SHEETS and discussed the Emergency Procedures for Huntington Middle School with my student.

• STUDENT INSURANCE: We have read the Myers-Stevens brochure and have indicated our intentions to elect/or not to elect coverage. The District form has been signed and will be returned to school. We understand that the 2013-2014 application form, in the packet, must be completed by the parent and mailed to the insurance company in the envelope provided.

The San Marino Unified School District Office is providing our signature documents through the District Web-Site http://www.smusd.us/under Parents and Students scroll to the First Day Packet button. Please refer to each document and acknowledge your receipt below.

I have read and understand the following documents provided by the Superintendent’s District Office.

• Notice of Rights of Parent or Guardians of Minor Pupils Under Certain Education Code Sections

• California Education Code Parental Notification Requirements

• Student Use of Technology

• Emergency Procedures and Disaster Preparedness

• State of California Attendance Funding Letter

• Student Accident Insurance

• Annual Notification of Application of Pesticides

• Student Injuries and Insurance Letter

• Media Letter

Your signature acknowledges receipt of all the above documents. We have read and understand all the sections of the First Day Packet Listed above. ___________________________________ ______________________________ Student Signature Parent/Guardian Signature

H. E. Huntington Middle School 1700 Huntington Drive San Marino, CA 91108

(626) 299-7060 A National Blue Ribbon School California Distinguished School

August, 2013

EXTRA CURRICULAR INSURANCE EXEMPTION STATEMENT To be signed by parents or guardians and filed with the office of Huntington School. DATE__________________ As parents and/or guardians of _________________________ __, we hereby; student name

1. Waive all medical, hospital, dental, and death benefits as provided for said student by the insurance plan of the San Marino Unified School District.

2. Release the San Marino Unified School District from any liability for the cost of care of any type

for said student which we, as his parents/guardians, are obligated by law to furnish as a result arising from participation in any athletic or extra curricular program of the San Marino Unified School district, except when such injury is due to the negligence of said district. As used herein, “negligence” does not include the failure to give said student a physical examination prior to or at any time during his participation in any athletic or extra curricular program

3. Acknowledge that my student does not have any known physical condition that would preclude

him/her from these extra curricular activities. ____________________________ ______________________________ Parent/Guardian Signature Relation to student _________________________________ _______________________ __________________ Street Address City State Zip Code This is in compliance with Section 31752 of the Education Code as amended by S.B. 1055 on July 21, 1965. This waiver applies to the 2013-2014 school year. THIS FORM MUST BE RETURNED TO YOUR STUDENT’S HOMEROOM TEACHER THE FIRST DAY OF SCHOOL IN ORDER TO PARTICIPATE IN SCHOOL ATHLETICS OR ANY OTHER EXTRA CURRICULAR ACTIVITY.

Please return this completed form and a check payable to the "HMS PTA" in the student First Day Packet, to the school office. Only 1 order form is needed per family. Make sure to total your order, write a check payable to "HMS PTA", write the check numberon the bottom of this Order Form, and include your child's (or children's) name on the check. Thank you!!!

PRINT CLEARLYStudent Name: Home RoomAddress:Phone Number: Parents Email:Parents Name:

Cost Quantity Amount

PTA Membership Dues: $6.00 individual $12.00 for familySupports national, state and local PTA-sponsored educational programs, $6.00child advocacy, newsletters and more. $12.00

PTA Budget Drive: $25 per student suggestedFunds vital programs such as Technology Center, Library, Music, CulturalArts along with all the PTA-sponsored events and programs. Thesewould not continue without your support.

HMS Directory: $15 per directoryBound book contains class lists, contact information and important schoolinformation.

Teachers Wish List: $25 per student suggestedSupports a discretionary fund that allocated an allowance for each HMSteacher to spend on educational and classroom supplies in their own class to enhance curriculum and enrich the learning experience.

HMS Instructional Supplies: $85 per student suggested $85 per childProvides Instructional Materials and Technology Equipment that eachHMS student will benefit.

Earthquake/Safety Supplies (ALL HMS Students): $10 per student $10 per childIndividual earthquake supplies for new students to HMS.

6th Grade Dances: This is for 6th Graders ONLY. Prepay and Save $40 per childDances are: 9/13, 11/15, 3/14 and 4/25

Patron donation for Hauntington Breakfast: $250, $100, $75, $50, other.Please support our biggest fundraiser by being a Patron. Any and alldonations are appreciated. Hauntington Breakfast is on October 26, 2013.

Patron donation for Parent Party:Please support our Parent Party. Any and all donations are appreciated!Parent Party will be on March 1, 2014. Location to TBD.

Huntington Heroes: $750 for 1 student, $1,250 for 2 students, $1,500 for 3You will be a noted sponsor of the Hauntington Breakfast, Magazine Driveand Parent Party. Your child(ren) will be able to participate in the trip toKnott's, Inflatable Day, and another amusement park WITHOUT sellingtickets. This is a simple way to support programs and not sell.

TOTAL AMOUNT

Check #

HUNTINGTON MIDDLE SCHOOL PTA ORDER FORM

$25 per child

The Henry E. Huntington PTA is a non-profit 501( c)(3) organization, with Federal tax identification # 95-6116587.

$25 per child

Order Items:

$15 each

Dear Parent(s): If you would like to have your information published in the 2013 - 2014 Huntington Middle School directory then we ask that you complete this form. After filling in the necessary information, please review yours and your child(s) information carefully as the information may differ. The child and parent names should reflect the preferred moniker. Please PRINT CLEARLY. Clearly differentiate between ‘1’ (the digit one ) and ‘l’ (lowercase L ) and ‘0’ (the digit zero) and ‘o’ (lowercase ‘o’ or uppercase ‘O’).

Child Name: Homeroom: Parent 1’s Name: Parent 2’s Name: Child’s Address: Telephone number: e-mail:

Please note that the child’s and parents’ names will always appear in the directory. The address, phone, and email will appear in the directory unless you indicate otherwise. Check the choice(s) that reflect your wishes.

NONE- Do NOT publish ANY of my information. Do NOT publish my Phone. Do NOT publish my Address. Do NOT publish my Email(s). Publish Mother and Father’s contact information separately.

e-mail: new

change (delete above email(s) addresses and use this) add another email address, up to 3 addresses per family)

_____________________________________________________________________ (write clearly and legibly)

The school district information is used only by the PTA, the Schools Foundation, and other non-profit organizations directly affiliated with the San Marino Unified School District, and is not released to other commercial interests or other agencies outside the community. Please be reminded that the personal information provided in the school directory is private. No individual may share this information with another individual or group without written permission of the superintendent. To PERMANENTLY change your information, appear at San Marino Unified School District located at 1665 West Dr., San Marino, CA 91108. Please sign and return this form with the First Day Packet information so we can print and distribute the directory shortly thereafter. We thank you for your cooperation and assistance. Parent signature: ____________________________________________________________________________ Comments or other information: _______________________________________________________________________________________ _______________________________________________________________________________________

The HMS Health Office Needs Your Help! Volunteering in the Health Office gives you a rewarding opportunity to help Huntington Middle School students and stay involved with the school throughout the year. Our volunteers are needed to staff the Health Office from 8:30 a.m. – 12:15 p.m., Monday through Friday, and/or 1:00 – 2:50 p.m. on Thursday, two to four times a year. No medical or nursing experience is required. There will be a Health Office orientation at the Middle School in early September for all interested volunteers. For more information, call Helen Spitzer at (626) 584-6939 or e-mail Helen at hspitzer@socal.rr.com

Interested? Complete the bottom half of this form & return it with your First Day Packet.

---------------------------------------------------------------------------------------------------------------------

HEALTH OFFICE VOLUNTEER Please circle your preference: 1. I want to work in the Health Office on the following days (from 8:30 a.m. – 12:15 p.m.)

Monday Tuesday Wednesday Thursday Friday

or Doesn’t Matter __________ 2. I want to work in the Health Office on Thursday (from 1:00 – 2:50 p.m.) 3. I would prefer to volunteer during the specified week of each month.

1st week 2nd week 3rd week 4th

week 5th week

or Doesn’t Matter __________

Name________________________________________ Phone _________________ E-mail_______________________________________________________________ If you are not able to work on a rotating schedule, would you like to be a substitute volunteer? _________________ Are you available for special projects? (vision/hearing, scoliosis screening) ___________

THANK YOU FOR VOLUNTEERING! Helen Spitzer, Health Office Volunteer Coordinator

HUNTINGTON MIDDLE SCHOOL PTA Volunteer Form

2013- 2014 The PTA and students rely on your volunteer efforts to make every program a success. Please indicate which area(s) you are interested in helping. Don’t worry if you are unable to commit far in advance. Your name will be given to the respective chairperson and you will be contacted as the event draws near. The PTA is always looking for new and familiar faces to make the school year a success for our students. Thank you for volunteering! STUDENT NAME: __________________________________________________ GRADE: _____ PARENT NAME: Last _____________________________________ First _____________________ (Parent1/Guardian) Last _____________________________________ First _____________________ (Parent2/Guardian) EMAIL: ___________________________________________________________ Phone: ____________________ Volunteer Opportunities! On

Campus Online One-

time* Campus Beautification – help with gardening projects on campus Clothing – help distribute HMS clothing throughout the year Community Relations – help with translations (please indicate language): _______________________________________

Courtesy & Hospitality – help bring food for PTA meetings Curriculum Lab Hauntington Breakfast on October 26, 2013 (also see separate volunteer form) General Help Tickets – help count money and/or distribute tickets Prizes – help with prize distribution Shift work – help on the day of event Set up/Take down – help the day before event and/or after event

Health & Wellness Committee – help implement community events focused on healthy lifestyles

Library – help with Library projects Magazine Drive: General Help Order processing – help count money and/or enter orders Prizes – help with prize distribution

Noontime Activities – help with crafts and/or activities during lunch (Fridays) Room Representative – interested in helping in your child’s home room class? Teacher Appreciation Luncheons – help bring food, set up and clean up Traffic Safety – supervise safe drop-off and pick-up before and after school

* You can sign up for these opportunities on a one-time only or one-event only basis.

If you have any questions regarding volunteer opportunities, contact Stephanie Perry, sperry1@socal.rr.com

SAN MARINO UNIFIED SCHOOL DISTRICT 2013 – 2014 Lunch Prepayment Form

Please complete and return the payment form below with your lunch payment checks OR make payments online by logging on to

www.mySchoolBucks.com

To access the online payment system type www.mySchoolBucks.com and follow the instructions.

This system allows you to monitor daily transactions and to sign up to receive Low Balance Alert. The low Balance

Alert serves as a reminder when your child’s lunch account has a low balance.

The price quoted below is a monthly estimate for a school lunch only; all other purchases will require additional money.

Any leftover balance will be carried over to the next month. If you would like to set a daily limit please call the Food Service Office.

Credits are no longer allowed please remember to always maintain a positive balance.

*****LUNCH PRICE ONLY***** A la Carte purchases will require additional money

Complete and return this portion with your payment.

Make check payable to: [insert your child’s school name here] Cafeteria Payment form for 2013–2014

Mail to:

San Marino USD Food Service Department

1665 West Drive

San Marino CA 91108

GUARDIAN’S NAME: Dollar Amount

School

LIST STUDENT (S) NAME (S) BELOW:

TOTAL

Duplicate as needed or download form and payment envelope at - www.smusd.us

Allow 48 hours for checks to be credited to your students' lunch accounts. Receipts will be issued only when requested.

PLEASE DO NOT SEND CASH VIA THE US MAIL. NOTE: CASH PRE-PAYMENT WILL NO LONGER BE ACCEPTED

For more information access our website, Thanks. - www.smusd.us

Carolle Thompson, Director Food Services - Phone: (626) 299-7000 X 323

E-mail: cthompson@smusd.us

Payment Methods Elementary Schools –

K-5 grades

Middle School

6-8 grades

High School

9-12 grades

Daily Cash $4.00 $4.50 - $5.00 $4.50 - $5.00

Monthly $ 100.00 (estimate only - unused

portion will be carried over)

$ 100.00 (estimate only - unused

portion will be carried over)

$ 100.00 (estimate only - unused

balance will be carried over)

Annual Prepayment $718.00 (182 lunches) Deposit as needed Deposit as needed

HMS-FDP

Investing in our Children’s Future As parents, we want the very best for our children, especially their education. The San Marino Unified School District has been ranked number one in the state for the past ten years, as measured by the Academic Performance Index (API). Beginning in kindergarten through our 12th grade graduates, our students thrive in an educational environment made excellent thanks to small class size, enhanced curriculum and academic innovation. Maintaining this level of educational excellence would not be possible without support from parents like you. We are all aware that existing public funding for our District has been insufficient to cover the costs of the tradition of educational excellence that we desire and our children deserve. A gift to the San Marino Schools Foundation is a gift to your children. Your generosity directly benefits your students by adding teachers to the classroom, offering relevant and expanded curriculum opportunities, and keeping teachers current and competitive. We request a tax-deductible donation of $2,000 per student. Each gift touches the lives of our students at Huntington Middle School, and every dollar makes a difference. Our goal this year is 100% participation. We encourage every Fox family to support their children’s education with a gift that matches their commitment and their circumstances. Thank you for supporting Huntington Middle School and San Marino Schools. Our children are counting on us.

John Cate Peter Koh Jason Kurtenbach President Annual Campaign Chair Principal

Choose one of three ways to make your 2013-14 Annual Campaign Donation (Please return this form with your child’s First Day Packet, with your attached check or credit card information)

� Send your check for $ _________ - payable to SMSF -- Please fill in your name, address, student, and phone information below.

OR

� Make a one-time credit card donation of $ _________ (Please complete the credit card and demographic information below) OR � Make a Pledge of $________ for the fiscal year 7/1/13 - 6/30/14. Schedule billing reminders or charge my credit card payments: � $_____/month � $_____/quarter � other $_____/ ______

For credit card transactions please fill in information below: � MasterCard or � Visa Card # __________________________________________________ Exp. Date _____________ Signature: _____________________________________________________________________ Parent/Guardian Name: ___________________________________________________ Student(s) Name: ________________________________________________________

Address: ______________________________ City, State & Zip: ____________________

Phone: __________________ Email: ____________________

Corporate matching gifts program can significantly boost your donation to the Schools Foundation. Check with your Human Resources Office and enclose the necessary forms. � Expect a corporate matching gift from _____________________________________

√ Giving Categories**

� $10,000 or more (Founder)* � $5,000 to $9,999 (Patron)* � $4,000 to $4,999 (Benefactor)* � $3,000 to $3,999 (Sponsor)* � $2,000 to $2,999 (Donor)* � $1,000 to $1,999 (Friend) � $1 to $999 (Contributor)

* Invited to Recognition Party **All SMSF donors will be listed by Giving Categories in our Annual San Marino Tribune Thank You ad unless otherwise indicated below.

� Do not include my/our name in any published lists.

� Do not give me/us Yard Sign

recognition in May 2014.

The San Marino Schools Foundation is a 501(c)(3) non-

profit corporation; donations are tax deductible.

Correspondence may be directed to: SMSF, 1665 West Drive, San Marino, CA 91108.

626/299-7014. Donate on-line at the Foundation’s website:

www.smsf.org

Partnership for Awareness (“PfA”) cares about the issues the youth in our community face today. The non-

profit organization, in coordination with the schools in our community, work to educate, advise, and empower

parents and youth in areas such as self-esteem, internet safety, social media, bullying, drug & alcohol abuse, and

more. As the social issues of the moment evolve, PfA hopes to be ready to equip and assist in a relevant way.

The Mission of Partnership for Awareness is:

• To increase awareness of critical issues challenging the health and well-being of San Marino youth;

• To identify and address such issues in cooperative partnership with parents, students, educators and

community groups;

• To provide a forum to educate the San Marino community (both adults and children) with knowledge

and skills to facilitate the successful navigation of these important issues.

Since 1979, PfA’s diverse programs have educated parents and students on key issues including:

• Annual Programs e.g. Red Ribbon Week: national campaign for awareness on substance abuse

• Student Programs e.g. Rachel’s Challenge: promoting compassion; “Bully for You” & ”I’m Stressed!”

• Parenting Programs e.g.“Homework without Hassle” & “Internet Safety” & ”The Teen Brain”

• Community-wide Programs e.g. Wendy Mogul, nationally renowned author of Blessings of a Skinned Knee;

Michael Thompson, author of NY Times best-seller Raising Cain addressed 500 people in the Spring 2010 and once

again in the Fall of 2012; Ashley Merryman, co-author of NY Times best-seller NutureShock: New Thinking about

Children gave a presentation in Spring 2011; Judith Rothe, author of the Neurotic Parent’s Guide to College

Admissions spoke to us in an intimate setting in the Spring of 2012.

PROGRAMS OF THIS QUALITY CAN ONLY CONTINUE WITH YOUR GENEROUS DONATIONS!

PfA has been solely supported by your donations since its inception in 1979

Please visit our website for further information: www.partnershipforawareness.org

Support Partnership for Awareness today!

[ ] $150+ Benefactor Gift of one Publication from a Guest Speaker/Author plus all the Benefits below

[ ] $ 75+ Family Preferred Seating at ALL Events plus all the Benefits below

[ ] $ 40+ Individual Free admission to ALL Events & a Complimentary Newsletter

[ ] $_____ Supporter

Corporate Matching Gift programs can significantly boost your donation to PfA. Please contact Development Chair

Helen Kim Spitzer@ hspitzer@socal.rr.com.

I wish to donate using a Corporate Matching Gift from my Company:______________________________________

Name for Publication as Donor: [ ] I do NOT want my name listed as a PFA donor (check if applicable)

Dr./Mr./Mrs./Ms. First Name _________________________ Last Name ________________________________

Address _____________________________________________________________________________________

Telephone ________________________________________ Email Address ________________________________

Please make checks payable to: Partnership for Awareness

Please staple check to bottom portion of this form and return to school with your Registration Packets or

Mail to: Partnership for Awareness, 1613 Chelsea Road, Suite 154, San Marino, CA 91108

Thank you for your support! Your contributions are tax deductible to the extent provided by the law.