“People Who Are Crazy Enough To Think They Can Change The World, Are The Ones Who Do.” Rob Siltanen

Weekly Mustang Memo

Week of November 2nd, 2020

Important Dates○ Wednesday, November 4th Marshall

Chipotle Night Out ○ Boo To The Flu November 6th ○ November 10th & 12th release time:

Kinder 12:30 pm Grade 1-5 1:10 pm ○ No School November 11th (Veterans

Day)

Grab and Go MealsGrab and Go Meals are served from 11:30-12:30 pm Monday-Friday at Marshall. Please know that food is served at the following sites: Marshall, CVE, CVHS, Creekside, Independent and Proctor. Food Pantry at Marshall-There is food that families have access to during the Grab and Go meals just ask.

Boo To The Flu November 6th @ Castro Valley Adult School. See attached flyer for more information.

November 10th and 12th release times

● Kindergarten will be released at 12:30 pm● Grades 1-5 will be released at 1:10 pm ● There will be no afternoon meetings held after the release times.

Marshall PTA information

Marshall Parent Support Circle: Join us for the second get-together this coming Saturday 11/7/2020 10 a.m. to 11 a.m. via Zoom. The parent circle is a safe space for parents to share challenges, discuss concerns, and gain new tools to support themselves and their child(ren) at home.

Join Zoom Meeting here: https://tinyurl.com/yxnnuuuw

Meeting ID: 970 7044 6577 Meeting Password: 736939

Join meeting by phone: Dial 1-669-900-6833

Chipotle Restaurant Night: Come in to the Chipotle at 3369 Castro Valley Blvd in Castro Valley on Wednesday, November 4th between 4:00pm and 8:00pm. Tell your friends, families, and neighbors! Show the attached flyer on your smartphone or tell the cashier you’re supporting Marshall School PTA to make sure that 33% of your purchase gets donated to our school! Ordering online for pickup? Enter promo code: LV2JLHJ before you checkout. Don't forget to click APPLY after you enter the promo code. Please note, delivery orders are not qualified.

Marshall Elementary School

11/2/2020 https://mail.google.com/mail/u/0/#inbox?projector=1

https://mail.google.com/mail/u/0/#inbox?projector=1 1/1

Seasonal Flu Vaccine Screening / Consent Form

The following questions will help us determine if there is any reason we should not give you or your child inactivated injectable influenza vaccination today. If you answer “yes” to any question, it does not necessarily mean you (or your child) should not be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your healthcare provider to explain it.

Patient’s Patient’s Patient’s First Name: __________________________ Last Name: ______________________________ Date of Birth: _____/_____/_____ Zip Address _____________________________________ City: __________________________ Code: _____________Age:_______

Phone Mother’s Number: __________________________________ Gender: ____________ First Name: ____________________________ Race and Ethnicity Information (check all that apply)

Asian American Indian or Alaska Native Black or African American White Native Hawaiian or Other Pacific Islander Hispanic or Latino Other ________________ More than One Race

Health Insurance Information (check all that apply) – This service is free, you will not be charged

Alameda Alliance – Medi-Cal Blue Cross – Medi-Cal Kaiser – Medi-Cal No insurance

United Health Care Blue Cross – Private Kaiser – Private Cigna

Blue Shield Health Net Aetna Other: ___________

Medical Information

1. Do you feel sick today or have a fever? Yes No

2. Do you have allergies to medications, eggs, a vaccine component, or latex? Yes No

3. Have you ever had a serious reaction after receiving a flu vaccination? Yes No

4. Have you ever had Guillain Barre Syndrome? (A severe paralytic illness also called GBS) Yes No

5. For women: Are you pregnant or currently breastfeeding? Yes No

VACCINE ADMINISTRATION CONSENT SIGNATURE

I received a copy of the Influenza vaccine information statement (VIS). I read it or had it explained to me. I had an opportunity to ask questions which were answered to my satisfaction. I understand the benefits and the risks of the vaccine and request that the vaccine indicated be given to me or to the person named on the registration form for which I am authorized to make this request.

Authorized Signature: _____________________________________ Date: ____________________________ (Self/Parent/Guardian)

The California Immunization Registry (CAIR) is a confidential, secure computer system supported by the California Department of Health. The system makes it easier for doctors, patients and parents to keep track of shots over a lifetime. Thousands of California doctors use CAIR. A record of the vaccine you received today will be entered in the CAIR system. Check this box if you DO NOT want your vaccination to be shared with healthcare providers who use CAIR.

FOR STAFF USE ONLY After completion, please Fax this to 510-268-2333 or send copies to ACPHD, Attn: Ella Leung, 1000 Broadway, Suite 500 – Oakland CA 94607

Vaccine type:___________________________ Dose:__________________ Manufacturer: ________________________

Lot #: __________________________ Expiration Date: _____________________ Injection Site: RD LD LT RT

Clinic/Site Name and City_____________________________________________________ Credential:

Dispensing Health Care Provider’s Name and Signature: MD RN LVN NP PA Paramedic EMT AEMT

Name: _____________________________Signature: ____________________________ Date:_______________

Influenza (Gripe) -- Formulario para Registro de Vacuna

Las siguientes preguntas nos ayudarán a determinar si hay alguna razón por la cual hoy no debemos vacunar a usted o a su hijo/ hija con la vacuna contra la influenza inactivado. Si responde “sí” a cualquier pregunta, no significa necesariamente que usted o su hijo/ hija no deberían vacunarse. Simplemente significa que va a tener que responder a algunas preguntas adicionales que les vamos a hacer. Si una pregunta no está clara o usted no lo entiende, consulte a su proveedor de atención médica para que se la explique.

Autorización para la Administración de la Vacuna contra la Influenza He leído o me han explicado la “Hoja de Información Sobra la Vacuna Contra la Influenza.” He tenido la oportunidad de hacer preguntas las cuales fueron contestadas a mi satisfacción. Entiendo los beneficios y riesgos de la vacuna contra la influenza y solicito que se me administre o se le administre a la persona por quien estoy autorizando(a) para efectuar esta solicitud.

Firma: _____________________________________________ Fecha: ____________________________ (Yo / Padre / Guardián) El Registro de Vacunación de California (CAIR, por sus siglas en inglés) es un sistema informático seguro y confidencial administrado por el Departamento de Salud Pública de California que pone la información sobre vacunación a disposición de los proveedores de atención médica, incluyendo muchos médicos locales. Su registro de vacuna a partir de hoy se ingresará en CAIR. Marque este cuadro si NO quiere que la información sobre su vacuna sea divulgada a los

proveedores de atención médica que usan el CAIR.

Primer Fecha Nombre: _________________________ Apellido: ____________________________ de Nacimiento: _____/_______/________

Domicilio # Calle _____________________________________ Cuidad: __________________________ CP: ___________ Edad: __________ Nombre Teléfono: _______________________________ Sexo: ___________________ de su madre: _________________________

Raza u Origen Étnico: (Marque todas las opciones que correspondan)

Asiático Indio Estadounidense o Nativo de Alaska Americano Negro o Afroamericano Blanco Nativo de Hawái o de las islas del Pacifico Hispano o Latino Otro ________________ Mas de una raza

Información sobre seguros médicos (Marque todas las opciones que correspondan) – Este servicio es gratis, no se le cobrará a usted

Alameda Alliance – Medi-Cal Blue Cross – Medi-Cal Kaiser – Medi-Cal No tiene seguro

United Health Care Blue Cross – Privado Kaiser – Privado Cigna

Blue Shield Health Net Aetna Otro: ___________

Antecedentes Médicos – Es necesario que conteste todas las preguntas

1. ¿Estás enferma/o hoy? ¿Tienes fiebre? Sí No

2. ¿Eres alérgico al látex, huevos, medicamento o algún componente de la vacuna? Sí No

3. ¿Has tenido alguna vez una reacción severa después de recibir una vacuna de influenza? Sí No

4. ¿Tuvo alguna vez el síndrome de Guillain-Barre? Sí No

5. Para las mujeres: ¿Está embarazada o amamantando? Sí No

Para las mujeres: ¿está embarazada o amamantando?

FOR STAFF USE ONLY After completion, please Fax this to 510-268-2333 or send copies to ACPHD, Attn: Ella Leung, 1000 Broadway, Suite 500 – Oakland CA 94607

Vaccine type:___________________________ Dose:__________________ Manufacturer: ________________________

Lot #: __________________________ Expiration Date: _____________________ Injection Site: RD LD LT RT

Clinic/Site Name and City_____________________________________________________ Credential:

Dispensing Health Care Provider’s Name and Signature: MD RN LVN NP PA Paramedic EMT AEMT

Name: _____________________________Signature: ____________________________ Date:_______________

季節性流感疫苗篩查 / 同意書

以下問題將幫助我們確定，是否存在任何理由讓我們今天不應該給您或您的孩子接種滅活注射流行性感冒疫苗。

假如您對任何問題回答“是”，這並不一定意味著您（或您的孩子）不應該接種疫苗，而只是意味著必須進一步

向您詢問而已。如果您對某個問題不清楚，請向您的醫療保健提供者尋求解釋。

病人名字: __________________________ 病人姓氏: ______________________________ 病人生日: _____/_____/_____

郵遞

地址 _____________________________________ 城市: __________________________ 區號: _____________年齡:_______

電話號碼: __________________________________ 性別: ____________ 母親名字: ____________________________

族裔資訊（勾選所有適用項）

亞裔 美國原住民或阿拉斯加原住民 黑人或非裔美國人

白種人 夏威夷土著或其他太平洋島民 西班牙裔或拉丁裔

其他________________ 多於一種族裔

醫療保險資訊（勾選所有適用項） – 本服務免費，不會向您收取費用

Alameda Alliance – Medi-Cal Blue Cross – Medi-Cal Kaiser – Medi-Cal 沒有保險

United Health Care Blue Cross – Private Kaiser – Private Cigna

Blue Shield Health Net Aetna 其他: ___________

醫療資訊

1. 您今天是否覺得不舒服或者發燒？ 是 否

2. 您是否對藥物、雞蛋、某種疫苗成分或乳膠過敏？ 是 否

3. 您此前是否在接種流感疫苗后出現過嚴重反應？ 是 否

4. 您是否患過吉巴氏綜合症？（一種嚴重的癱瘓疾病，亦稱 GBS） 是 否

5. 對於女性：您是否懷孕或正在進行母乳餵養？ 是 否

疫苗接種同意書簽名

我已收到一份流行性感冒疫苗資訊聲明（VIS）。我已將其閱讀或讓人向我解釋其內容。我已有機會提出問題，並且得到了

令我滿意的回答。我瞭解疫苗的益處和風險，並申請將指定疫苗提供給我或登記表上列名的我有權為其提出申請的人。

授權簽名： ____ _________________________________ 日期: ____________________________ （本人/家長/監護人）

加州免疫登記系統（CAIR）是一個保密、安全的電腦系統，由加州衛生部支持。該系統使醫生、病人和家長更容

易追蹤記錄一生以來進行的各項注射。成千上萬的加州醫生使用 CAIR。您今天接種疫苗的紀錄將輸入 CAIR系

統。 如果您不希望您的疫苗資訊共享給使用 CAIR 的醫療提供者，請勾選此框。

FOR STAFF USE ONLY After completion, please Fax this to 510-268-2333 or send copies to ACPHD, Attn: Ella Leung, 1000 Broadway, Suite 500 – Oakland CA 94607

Vaccine type:___________________________ Dose:__________________ Manufacturer: ________________________

Lot #: __________________________ Expiration Date: _____________________ Injection Site: RD LD LT RT

Clinic/Site Name and City_____________________________________________________ Credential:

Dispensing Health Care Provider’s Name and Signature: MD RN LVN NP PA Paramedic EMT AEMT

Name: _____________________________Signature: ____________________________ Date:_______________

SCHOOLSPIRITTASTESGREAT

Make dinner a selfless act by joining us for a fundraiser to support Marshall PTA. Come in to the Chipotle at 3369 Castro Valley Blvd in Castro Valley on Wednesday, November 4th between 4:00pm and 8:00pm. Bring in this flyer, show it on your smartphone or tell the cashier you’re supporting the cause to make sure that 33% of the

proceeds will be donated to Marshall PTA.

NEW! ORDER ONLINE FOR PICKUPUse code LV2JLHJ before checkout in ‘promo’ field. Orders placed on Chipotle.com or through

the Chipotle app for pickup using this unique code will be counted towards the fundraiser.

All online orders must be placed for pickup at the same time/location of the fundraiser. Delivery cannot be counted at this time. Gift card purchases during fundraisers do not count towards total donated sales, but purchases made with an existing

gift card will count. $150 minimum event sales required to receive any donation.

ELCAMBIOQUEUNOCREA

Haz que la cena sea un acto generoso uniéndote a nosotros en un evento de recaudación de fondos para apoyar a Marshall PTA. Acude al Chipotle

en 3369 Castro Valley Blvd el Wednesday, November 4th, entre las 4:00pm y las 8:00pm. Trae este volante, preséntalo en tu teléfono o dile al cajero que estás apoyando la causa con el fin de asegurar que el 33%

de los ingresos se done a Marshall PTA.

NUEVO! ORDENA EN LÍNEA PARA RECOGER.Usa el código LV2JLHJ en la casilla de información denominada ‘promo‘. Sólo las ordenes que

usen este código identificador y encargadas para recoger, vía chipotle.com o por la aplicación de Chipotle, contarán como válidas para la recaudación de fondos.

Todos los encargos en línea para recoger deberán ser de el mismo lugar del evento y en el tiempo precisado por la recaudación de fondos. Servicio a domicilio no será considerado válido. Compras de tarjetas de regalos durante la

recaudación de fondos no contarán hacia el total de ventas donadas, pero sí contarán las ordenes puestas con una tarjeta de regalo ya existente. Se requiere un mínimo de $ 150 dólares de ventas para recibir cualquier donación.

ONLINE FUNDRAISERSCongratulations on your upcoming Chipotle fundraiser! Below are details on how to participate in your fundraiser online through the Chipotle App or Chipotle.com.

Access the Chipotle app or order on our website.1Choose “Pickup” and select the location of the restaurant which is hosting your fundraiser.

2Delivery orders or orders placed through

other apps will not be counted towards

your fundraiser.

Build your order with all your faves.3Once you’re ready to place your order, input your unique online fundraiser code in the “Enter a Promo Code” section. Don’t forget to click “Apply.”

4

Provide payment information and submit your order for pickup (not delivery). Reminder, pickup must be within the hours of your scheduled fundraiser.

5

If you or your supporters forget to input and apply the code at checkout, please email us your order information at fundraisers@chipotle.com.

Please note all online orders for your fundraiser must be within your

scheduled hours and only at the restaurant hosting your event.

Once you apply your fundraiser code, your cart will show “Fundraiser” and an amount of -$0.01. Don’t panic — this is totally normal and how we track the code in our system.

HELPFUL TIP