Olentangy Hyatts Middle School Back to School Information

Transcription

1 Olentangy Hyatts Middle School Back to School Information Hyatts Middle School will be offering times for students/parents to come into the building to prepare for the school year! PTO will be available at all back to school times selling spirit wear. School staff will be available to answer questions regarding PowerSchool & Schoology, special education services, and gifted services. See below for grade specific information. If you are unable to make the back to school times, schedules will be available Wednesday, August 9 th at 8:00 a.m. through PowerSchool, and picture makeups will take place Friday, August 18 th. All grades Optional: Special Education meet and greet with the department chair on Thursday, August 10 th, 2017 from 9:00 a.m. to 11:00 a.m. Optional: A Gifted coordinator will be available to answer individual questions Wednesday, August 9 th from 9 a.m a.m. and again on August 10 th from 4 p.m. 6 p.m. 6 th grade The sixth graders will participate in WEB (Where Everyone Belongs) on Thursday, August 10 th, 2017 from 9 a.m a.m. Please drop off students at the back of the building. (Pick up in front at the end of WEB) Students can expect to: Receive a copy of their daily schedules Have their pictures taken Tour the building Participate in team building activities with 8 th grade WEB Leaders Receive a packet with additional information Parents are welcome to enter the front of the building to complete the following: Pay fees Pick up school supplies Drop off clinic information Ask any questions! 7 th and 8 th grade 7 th and 8 th grade students can attend Back to School times on Wednesday, August 9 th at 9 a.m a.m. or 4 p.m. - 6 p.m. The following will be available during this time: Schedule pick up Student pictures taken Fee payment School supply pick up Clinic forms Washington D.C. questions/form pick up Ask any questions! **Please note we will only honor schedule changes during the back to school times for students with errors in their schedules. We will take schedule preference requests in writing only. Those requests can be turned in at the front office or ed to latoya_davis@olsd.us. Thank you in advance!

2 Hyatts Middle School Supply List 6th Grade Supply List 7th Grade Supply List 8th Grade Supply List 4 Pencils, sharpened, #2, 1 dozen 5 Pencils, sharpened, #2, 1 dozen 6 Pencils, sharpened, #2, 1 dozen 2 Washable Glue Sticks, 0.74 oz 1 Washable Glue Stick, 0.74 oz 2 Pens, medium point, blue, 12 pack 1 Loose Leaf Paper, college ruled, 200 pk. 1 Elmers Glue, squeeze bottle 2 Loose Leaf Paper, college ruled, 200pk. 2 Three ring binders, 1.5", any color 2 Loose Leaf Paper, college ruled, 200 pk. 1 Chromebook 2 Three ring dividers, 5 tab 3 Three ring binders, 1" inch, any color 1 Colored pencils, 12 count 1 Three ring binder, 1-1/2, any color See Power Up Olentangy (BYOD) for a list of district approved devices 1 Highlighter, chisel tip, any color 4 Three ring dividers, 5 tab * INDIVIDUAL 8TH GRADE TEACHERS WILL Plastic Folders w/pockets & fasteners: (red, 1 Colored pencils, 12 count REQUIRE BINDERS, NOTEBOOKS & DIVIDERS 4 blue, yellow, purple) ACCORDING TO SPECIFIC CLASS NEEDS 2 Ink Pens, medium point, NOT black or blue 3 Sharpies, 2-Black, 1- any color 1 3x5 Index Cards, ruled, 100 pack 1 Dry Erase Markers, 4 pack 1 Composition Book, wide ruled, 100 sheets 4 Highlighter, chisel tip, any color 1 Facial Tissues, 200 count 1 3x5 Index Cards, ruled, 100 pack 1 Post-it Notes, yellow, 3"x3", 100 sheets 1 Facial Tissues, 200 count 1 Pencil case, zippered, 3 holed, fabric, 10x6 2 Spiral Notebook, 1 subject, college ruled Scientific Calculator, TI-30 1 HIGHLY RECOMMENDED 1 Scissors, 7", pointed tip 1 Scientific Calculator, TI-30 2 Plastic folders 1 Post-it Notes, yellow,3"x3", 100 sheets 1 Pencil case (OPTIONAL) ** Note that individual teachers may ask for additional supplies that pertain to their classes. They will communicate this on the first day of school. Foreign language classes will distribute their school supply needs on the first day of school. *** Please note that some of the above items may need to be replenished throughout the school year if used or lost.

3 DAILY SCHEDULE Period 6th Grade 7th Grade 8th Grade 1 7:40-8:15 Advisory 7:40-8:15 Advisory 7:40-8:15 Advisory 2 8:17-9:12 Core 1 8:17-9:03 UA1 8:17-9:09 Core 1 3 9:14-10:09 Core 2 9:06-10:00 Core 1 9:11-9:56 UA1 4 10:12-10:57 UA1 10:02-10:56 Core 2 9:59-10:50 Core :00-11:30 Lunch 10:59-11:43 UA2 10:52-11:42 Core :33-12:03 Student Assist 11:45-12:15 Lunch 11:45-12:30 UA2 7 12:05-1:00 Core 3 12:18-12:48 Student Assist 12:33-1:03 Lunch 8 1:02-1:57 Core 4 12:51-1:47 Core 3 1:05-1:54 Core 4 9 2:00-2:45 UA2 1:49-2:45 Core 4 1:56-2:45 Core 5 Unified Arts Core Foreign Language 8:17-9:03 UA71 9:59-10:50 Core FL 9:11-9:56 UA81 1:05-1:54 10:12-10:57 UA61 10:59-11:43 UA72 11:45-12:30 UA82 11:00-11:30 2:00-2:45 UA62 11:45-12:15 12:33-1:03 Revision date: January 5th, 2017 Core FL Lunch 6th Grade 7th Grade 8th Grade

4 7th Grade VACCINE REMINDER MENINGOCOCCAL A school requirement &TDAP for 7th graders Required Vaccines: Tdap vaccine Protects against tetanus, diphtheria & pertussis (whooping cough) Meningococcal vaccine This is a new requirement for 7th graders. It protects against bacterial meningitis Second dose will be required for 12th grade entry. Other CDC recommendations for teens include: Human Papillomavirus vaccine to protect against cervical cancer, genital warts & other cancers Varicella vaccine booster to protect against chickenpox Hepatitis A vaccine Annual Flu vaccine Please discuss vaccines with your family doctor or call the Delaware General Health District at (740) to speak with a public health nurse or schedule an appointment DelawareHealth.org

5 OLENTANGY LOCAL SCHOOLS EVENT CALENDAR SCHOOL YEAR AUGUST ELEMENTARY OPEN HOUSE 8/14/17 4:00 6:00 PM Elementary Teachers will be working 10 AM 6 PM CONVOCATION / BUILDING MEETINGS 8/15/17 JANUARY 2018 H H SEPTEMBER H OCTOBER NOVEMBER H DECEMBER H LEGEND First/Last days of school H Holiday Teacher work day Start of grading period End of grading period PD Day Two hour early dismissal CURRICULUM NIGHT 8/23/17 High School 8/24/17 Elementary (K 2) 8/30/17 Middle School 8/31/17 Elementary (3 5) REPORT CARDS AVAILABLE TO PARENTS 11/1/17 First Quarter 1/10/18 Second Quarter 4/4/18 Third Quarter 5/30/18 Fourth Quarter PARENT TEACHER CONFERENCES Parent Teacher Conferences will be held in the Spring and Fall. Each school will establish their own dates, times & process. Please contact your child s building for more information. GRADUATION DATE / TIMES: SUNDAY, MAY 20, :00 AM OOHS 1:00 PM OHS 4:00 PM OLHS FEBRUARY H MARCH APRIL MAY H JA/1/26/17/Final

6 AUGUST SEPTEMBER H OCTOBER NOVEMBER H DECEMBER H OLENTANGY LOCAL SCHOOLS CALENDAR SCHOOL YEAR Board Approved April 14, 2016 AUGUST Teacher work days 14 Elementary Open House 15 Convocation & building meetings 16 First day of school SEPTEMBER Labor Day No school 18 Professional Development No school OCTOBER COTA Day No school 20 End of First Quarter NOVEMBER Conference Exchange Day No school 23/24 Thanksgiving break 27 Professional Development No school DECEMBER End of Second Quarter; end 1 st semester WINTER BREAK ~ DEC. 22, 2017-JAN. 2, 2018 JANUARY Teacher work day No school 3 Classes resume 15 M.L. King, Jr. Day No school FEBRUARY Professional Development No school 19 Presidents' Day No school MARCH End of the third quarter SPRING BREAK ~ MARCH 26-30, 2018 APRIL Conference Exchange Day No school MAY Last day of school (Two-hour early dismissal for K-5) 23 Teacher work day 28 Memorial Day LEGEND First/Last days of school H Holiday Teacher work day Start of grading period End of grading period Professional Development day Two-hour early dismissal JANUARY 2018 H H FEBRUARY H MARCH APRIL MAY H

7 Hyatts Middle School Food Service The Hyatts Middle School Food Service staff looks forward to serving you next year. As your student transitions from elementary school to middle school they will find many more opportunities in the cafeteria. The Meal Swipe System: Just like in elementary school, the cafeteria offers a debit system that allows students to put money on their account in advance to make purchases. Students may use the funds available on their account or cash for all purchases, including à la carte items and breakfast. After making their meal choices students take their tray to the cashier and enter their student ID number into a pin pad to allow the cashier to retrieve their account information. Students are kept informed of their debit balance. s will also be sent to you as the parent periodically if we have a current when their balance gets low and/or negative. Additionally, you will be able to check your child s balance, view recent purchases and make deposits online through your PowerSchool parent account. Please refer to Olentangy s administrative meal charge procedure in regards to charging. Lunch Pricing and the Meal Swipe Pattern: The current lunch price for a meal swipe is $2.75. A meal swipe like elementary consists of 5 components: an entrée, which is 2 components (a protein and a whole grain-rich grain), fruit (can select 1 serving), vegetable (can select up to 2 servings) and fat-free or low fat milk. To make the meal swipe students must select at least 3 out of the 5 components one of which must be either a fruit or a vegetable. What s offered: The monthly printed menu lists the three main entrée choices that are offered daily: a hot entrée, a hot sandwich, and a pizza selection. In addition, entrée salads, made to order deli wraps, subs and sandwiches, a yogurt entrée and meatless entrees are offered daily too. A variety of vegetables are offered daily including hot vegetables, a variety of fresh cut vegetables, tossed salad and vegetable juices. Fruit options will include a choice of several different fresh fruits, 100% fruit juice, canned fruits, and frozen fruit cups. Milk selections include 1% or fat free white and fat free flavored varieties. À la Carte: Students also have the option to purchase à la carte items. A list of these à la carte items along with current pricing is included and is available on the website. All foods offered are in compliance with USDA s Smart Snacks in Schools standards. Breakfast: Hyatts Middle School takes part in the National School Breakfast Program. Breakfast is offered daily to students before school starts. The breakfast price is $1.50 and includes a breakfast entrée, a fruit and/or vegetable, and milk. A limited selection of à la carte items will also be available for purchase at breakfast. Free and Reduced Meal Application: As part of the National School Lunch and Breakfast Programs, Olentangy Local Schools provide free or reduced price meals for qualifying students. Applications can be filled out online at or paper applications can be picked up at a school office or printed from our website at click on For Parents and then click on Forms District to access the free and reduced price meal application. Directions to find Your Guide to the Lunch Line Middle School Lunch 1. Go to the Olentangy Local Schools home page: 2. Click on Departments and then click on Food Service. 3. On either the top of the page or on the bottom of the page click on Menus. 4. Scroll down the page to the Your Guide to meal plans section and click on the Middle School Lunch link. Hyatts Middle School Food Service Manager: Lori Carr Lori olsd.us@olsd.us This institution is an equal opportunity provider.

8 Delicious & Nutritious! Your Guide to the Lunch Line How to Choose a Reimbursable Lunch in Middle School What is a Reimbursable Lunch? * What are the Goals of the National School Lunch Program? Safeguard the health & well being of the nation s children Encourage domestic consumption of nutritious agricultural foods Give children an understanding of the relationship between proper eating habits & good health The National School Lunch Program allows schools to receive money & foods from the U.S. Department of Agriculture (USDA) for each meal served. To receive the money and food schools must serve lunches meeting Federal requirements regarding nutrient content and portion sizes. A complete meal, meeting the requirements, allows a school to receive benefits and is referred to as a reimbursable lunch. Olentangy Local School District Olentangy Local School District 814 Shanahan Road, Suite 100 Lewis Center, Ohio 43035

9 It must include a fruit or vegetable! What Makes Up a Reimbursable Lunch? 5 Possible Components 1. Milk 5. Vegetable 2. Fruit *Allowed up to 2 servings The 5 Meal Components 1. Milk 2. Fruit 3. Meat or Meat Substitute (included within the entrée) 4. Grain (included within the entrée) 5. Vegetable *Allowed up to 2 servings Entrée Comprised of: Meat or Meat Substitute Grain Did You Know? Middle school students must take at least 1 serving of a fruit or vegetable. However, they may take up to 1 serving of fruit and 2 servings of vegetables in a meal for the same price!

10 A student needs 3 out of 5 components in order for a meal to be reimbursable. 1 of these 3 components must be a fruit or vegetable. 1. Fruit 2. Meat /Meat Substitute 3. Grain 1. Fruit 2. Vegetable 3. Milk 4. Meat 5. Grain 1. Fruit 2. Vegetable 3. Milk 4. Meat 5. Grain All of these are considered reimbursable meals! All of these meals cost $ Fruit 2. Milk 3. Vegetable

11 Why Choose a Reimbursable Meal? Benefits for Students: Students learn how to build a balanced meal, a lifelong skill important for healthy living. Research shows when a child s nutritional needs are met, the child is more attentive in class, has better attendance, & fewer disciplinary problems. USDA research shows children who participate in National School Lunch Programs eat healthier compared to those who do not participate. School districts participating in the National School Lunch Program are required to have a wellness policy which addresses obesity, promotes healthy eating, and encourages physical activity among students. Benefits for the School: The National School Lunch Program provides cash reimbursements, on a per meal basis, to schools providing free & reduced price lunches to eligible children. Schools receive USDA commodity foods for each lunch served. Benefits for Parents: School lunch offers parents a convenient way to provide a nutritious lunch for their children at the lowest possible price. If all five components of a meal were purchased separately it would cost $4.75, but when purchased as a reimbursable meal it would cost $2.50. This save $11.25 per week. That is about $415 dollars saved over the whole school year!

12 Grains Grains are made up of carbohydrates, which are an important energy source for the nervous system & red blood cells. Soluble fibers, found in grains, have been shown to lower cholesterol levels & blood glucose levels. This reduces the risk of cardiovascular disease & diabetes. Insoluble fibers, found in grains allow foods to move through the intestine faster. This can lower the risk of constipation, diverticular disease, & colon cancer Repeated studies have shown whole grains can reduce the risk of stroke, type 2 diabetes, heart disease, as well as improve weight management. Milk Milk is a great source of calcium, which is needed for lifelong healthy bones and teeth. Calcium is important for young people because 90% of bone mass is developed by age 17. The Fantastic Five! The 5 Components of a Meal Help Build a Strong Body & Mind Fruits & Vegetables Fruits & vegetables provide essential vitamins & minerals, & other nutrients that are important for growth. Fruits & vegetables are a good source of fiber which promotes healthy digestion & may help prevent colon cancer. Most fruits & vegetables are naturally low in fat & calories & keep you feeling full longer. Eating fruits & vegetable has been shown to reduce the risk of certain chronic disease. These diseases include stroke, type 2 diabetes, some types of cancer, & heart disease. Meat Meat is a valuable source of protein. Proteins provide structural support to vital body tissues and structures. Proteins also support the immune system. Meat & soy are the only foods that contain all 9 essential amino acids the body needs.

13 References age=22&gender=female&activity=sed

14 What Makes a Meal Swipe? CHOOSE 1 Entrée An entrée is the main dish. Purple signs will show your various daily entrée options. Fruit CHOOSE UP TO 1* Fruits are a side option and are labeled with red signs. CHOOSE UP TO 2* Vegetable Vegetables are a side option and are labeled with green signs. *You must take at least one serving of fruit or vegetable Milk CHOOSE 1 Milk comes with a meal swipe. À la Carte À la Carte items are not included in a meal swipe, but can be purchased separately for additional charge. These items are marked with yellow signs.

15 Start your day off Right! Your Guide to School Breakfast How to Choose a Reimbursable Breakfast in Schools What is a Reimbursable Breakfast? What are the goals of the National School Breakfast Program? Safeguard the health and wellbeing of the nation s children Encourage domestic consumption of nutritious agricultural foods Give children an understanding of the relationship between proper eating habits & good health. The National School Breakfast Program allows schools to receive money and foods from the U.S. Department of Agriculture (USDA) for each meal served. To receive money and food, schools must serve breakfasts meeting federal requirements regarding nutrient content and portion sizes. A complete meal, meeting these requirements, allows a school to receive benefits and is referred to as a reimbursable breakfast Olentangy Local School District 814 Shanahan Rd Suite 100 Lewis Center, OH Olentangy Local School District

16 3. Protein What Makes up a Reimbursable Breakfast? 2. Whole Grain-Rich Grain(s) 4 Possible Components 1. Fruit/ Vegetable/ Juice 4. Fat-Free or Low-Fat Milk The 4 Meal Components 1. Fruit/ Vegetable/ Juice* 2. Whole Grain-Rich Grain(s) 3. Protein 4. Fat-Free or Low-Fat Milk Entrée Entrée: 2 Grains or 1 Grain & 1 Protein An entrée may be made up of 2 grains OR 1 grain and 1 protein

17 A student needs 3 out of the 4 components in order for a meal to be considered reimbursable. *Students may take up to 2 servings of fruit, vegetable, or juice as part of their breakfast, but must select at least 1 serving. Component #1 & #2. Entrée (2 grains) #3. Fruit #4. Milk Component #1 & #2. Entrée (2 grains) #3. Milk #4. Fruit Juice Component #1 & #2. Entrée (2 grains) #3. Fruit Component #1 & #2. Entrée (1 grain & 1 protein) #3. Milk #4. Fruit Each of these breakfasts are considered to be reimbursable meals and cost $1.50 each!

18 Why Choose A Reimbursable Meal? Benefits for Students: Eating breakfast can help improve math, reading, and standardized test scores Children who eat breakfast are more likely to behave better in school and get along with their peers than those who do not/ Children who eat breakfast on a regular basis are less likely to be overweight Students get more of important nutrients, vitamins, and, minerals such as calcium dietary fiber, folate, and protein Eating breakfast as a child is important for establishing healthy habits for later in life Breakfast helps children pay attention, perform problem- solving tasks, and improve memory School breakfast provides ¼ the recommended amounts of protein, calcium, iron, vitamin A, and vitamin C for the day Benefits For Schools: The National School Breakfast Program provides cash reimbursements, on per meal basis, to schools providing free & reduced price breakfasts to eligible children Schools that provide school breakfast in the classroom to all students have shown decreases in tardiness and suspensions as well as improved student behavior and attentiveness Benefits For Parents School breakfast offers parents an convenient, safe, and nutritious alternative to breakfast at home at the lowest possible price If the above meal was purchased separately, it would cost $2.60, but when purchased as a reimbursable meal it costs $1.50. This will save you $5.50 per week. That is a savings of over $ for the whole school year!

19 \ Whole Grains The Fantastic Grains are made up of carbohydrates, which are an important energy source for the nervous system & red blood cells. Soluble fibers, found in grains, have been shown to lower cholesterol levels & blood glucose levels. This reduces the risk of cardiovascular disease & diabetes. Insoluble fibers, found in grains allow foods to move through the intestine faster. This can lower the risk of constipation, diverticular disease, & colon cancer Repeated studies have shown whole grains can reduce the risk of stroke, type 2 diabetes, heart disease, as well as improve weight management. Milk Milk is a great source of calcium, which is needed for lifelong healthy bones and teeth. Calcium is important for young people because 90% of bone mass is developed by age 17. Five! The Five Components of A Meal Help Build A Strong Body & Mind Fruits & Vegetables Fruits & vegetables provide essential vitamins & minerals, & other nutrients that are important for growth. Fruits & vegetables are a good source of fiber which promotes healthy digestion & may help prevent colon cancer. Most fruits & vegetables are naturally low in fat & calories & keep you feeling full longer. Eating fruits & vegetable has been shown to reduce the risk of certain chronic disease. These diseases include stroke, type 2 diabetes, some types of cancer, & heart disease. Protein Meat is a valuable source of protein. Proteins provide structural support to vital body tissues and structures. Proteins also support the immune system. Meat & soy are the only foods that contain all 9 essential amino acids the body needs.

20 References age=22&gender=female&activity=sed

21 BREAKFAST MEAL SWIPE ONLY $1.50 Food choices will vary daily CHOOSE ONE ENTRÉE APPLE CINNAMON FRENCH TOAST ENTRÉE BENEFIT BREAKFAST BAR BREAKFAST BURRITO / TACO BREAKFAST BAGEL / PIZZA BREAKFAST BREAD BREAKFAST SANDWICH BREAKFAST PASTRY/ WG POPTART FRUIT or VEGETABLE or JUICE MAY CHOOSE TWO FLAPSTICK FRENCH TOAST STICKS FRUDEL / BOSCO APPLE STICK ALL MINI ENTREES PANCAKES/ WAFFLES PBJ POCKET/ PBJ GRAHAM BAR OR MILK CHOOSE ONE CHOOSE COMBINATION OF 2 OF THE FOLLOWING: CEREAL DONUT HOLE MUFFIN STRING CHEESE YOGURT USDA is an equal opportunity provider and employer. MUST TAKE AT LEAST ONE FRUIT or VEGETABLE or JUICE

22 Olentangy Local Schools IMMUNIZATION EXEMPTION Student School Grade As required under the compulsory Immunization Law (Ohio Revised Code, Section ), I, the parent/legal guardian of the above named student, object to having him/her immunized for the following reason(s): You must check the appropriate box(s) AND explain your answer. Has Had the Natural Disease(s) of: (Check those that apply) Natural Rubeola Date: Natural Mumps Date: Natural Chicken Pox Date: Religious/Philosophical Objection: Medical Objection: MUST be accompanied by a note from your physician, (MD, DO, PA, or CNP), supporting the need for this exemption. DTaP /DPT/DT MMR #1 Polio MMR #2 Hepatitis B Varicella I understand that this exemption entitles my child to attend school only during those periods when the disease(s), for which my child is not immunized, is absent in the Olentangy Local School District. Upon the occurrence of an outbreak of the disease(s), my child may be excluded from school from the first reported case until two (2) weeks after the last reported case. Parent/Legal Guardian Signature Date

23 5330 F2a/page 1 of 1 PARENT S NON-PRESCRIPTION MEDICATION REQUEST FORM (Grades 6-12 only) Student s Name Grade Level As a parent or legal guardian of the above named child, I am requesting that he/she be allowed to carry and self-administer an over-the-counter medication. 1. I have instructed the student as to the proper use of this medication. 2. I understand that students are not permitted to possess or carry more than a one-day supply of any over-the-counter medication. 3. I release and agree to hold the Board of Education, its officials, and its employees harmless from any and all liability foreseeable or unforeseeable for the damages or injury resulting directly or indirectly from this authorization. 4. I agree that this form is in effect for the duration of the current school year unless stated below. Dates medication to be taken Grade Name of over-the-counter medication Parent s Signature(s) Date Signed

24 OLENTANGY LOCAL SCHOOLS MIDDLE SCHOOL FEE SCHEDULE Approved by the Board of Education on May 18, 2017 GRADES 6-8 GRADE/AREA/COURSE APPROVED FEE Sixth Grade Fees Agenda Book $6.00 Art $12.00 R/LA Paperbacks/Materials $15.00 Science $3.00 Cope Program (OLMS only) $15.00 Seventh Grade Fees Agenda Book $ 5.00 Life Skills $10.00 Mod Tech $9.00 R/LA Paperbacks/Materials $20.00 Science $ 3.00 Eighth Grade Fees Agenda Book $ 5.00 R/LA Paperbacks/Materials $20.00 Science $3.00 Activities Athletics (per sport) $80.00 Co-curricular and Extracurricular Activities (per activity or sport) $25.00 Summer Enrichment Experience for Grades 6-8 (SEE18) Registration Required $125 / COURSE Fees may differ by building but will not exceed the approved dollar amounts. FINAL 5/19//17/ja 1

25 OLENTANGY LOCAL SCHOOLS MIDDLE SCHOOL FEE SCHEDULE Approved by the Board of Education on May 18, 2017 GRADES 6-8 GRADE/AREA/COURSE APPROVED FEE Electives Band Book (Grade 6, 7, 8) $9.00 School Instrument Usage / Cleaning / Maintenance $20.00 Percussion Book (Grade 6, 7, 8) $16.00 Ceramics $12.00 Drawing $10.00 Global Gourmet I $15.00 Global Gourmet II $17.00 Language I Workbook/Materials $22.25 Painting $10.00 Sculpture $12.00 Woods $20.00 Art A $10.00 Art B $12.00 Choir $ 7.00 Strings $11.00 Mod Tech $ 9.00 Fees may differ by building but will not exceed the approved dollar amounts. FINAL 5/19//17/ja 2

26 5330 F2b/page 1 of 2 PHYSICIAN S MEDICATION PROCEDURE REQUEST FORM TO BE COMPLETED BY THE PHYSICIAN Child s Name Birth Date Child s Address Diagnosis Medication Dosage or Procedure Required Time Required Can a morning dose be given if forgotten at home? What is the morning dose? Should afternoon dose be adjusted? New Time Possible adverse reactions, which should be reported to the parent and physician: Special instructions for administration (including students carrying own meds): Date when administration of medication or procedure is to begin: Date when administration of medication or procedure is to end: Physician s Signature: Physician s Name: Physician s Address: Physician s Telephone Number: Physician s Fax Number:

27 5330 F2b/page 2 of 2 PARENT S MEDICATION PROCEDURE REQUEST FORM Student s Name Grade Level As a parent or legal guardian of the above named child, my signature below authorizes school personnel to administer the medication as instructed by the physician. I understand that a trained staff member administering the medication might not be a health professional. 1. I will deliver the medication to the clinic staff in its original container. 2. I will notify the clinic staff immediately if there is any change in the use of this medication or the prescribed treatment. 3. I release and agree to hold the Board of Education, its officials, and its employees harmless from any and all liability foreseeable or unforeseeable for the damages or injury resulting directly or indirectly from this authorization. 4. I agree that school officials are authorized to contact the physician on matters relating to the medication. 5. I agree that this form is in effect for the duration of the current school year unless stated below. 6. I have read the above statements and agree to them Parent s Signature(s) Date Signed Principal s Signature Date Signed