DC Forms 2016 2017
All of the information on this form needs to be submitted by Friday, February 3, 2017.
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Student Last Name *
Student First Name *
Student's STAR Teacher *
Click link for list of all 8th grade students and their respective STAR teacher. https://docs.google.com/spreadsheets/d/1hn92i1dMDYYViJctMSqaWejPahFsqmsFnbh5zvNKWaI/edit?usp=sharing
Parent 1 First Name *
Parent 1 Last Name *
Parent 2 First Name
Parent 2 Last Name
Part A; I grant permission for our my/our child to attend the OFMS trip to Washington DC on April 5, 6, & 7, 2017. *
I give my daughter/son permission to attend the Board of Education approved school trip to Washington, D.C. from Wednesday, April 5 - Friday, April 7, 2017.  I further understand that the following activities associated with this trip are such that school staff cannot directly supervise my child during certain segments of the trip (i.e. National Mall, Smithsonian Museums, Pentagon City Mall and Food Court, Reagan Food Court, and Hotel Room from 10:30 PM-8:00 AM). I understand that it may be necessary to share pertinent educational and/or medical information with staff and parent chaperones as it relates to the well-being of my child. In light of the above, I hereby give consent to my child’s participation in the trip and in the unsupervised activities.  
Part B. 1.: I hereby give my consent for the administration of any treatment deemed necessary by a physician or dentist and/or the transfer of my child to any hospital that is reasonably accessible both to, from, and in Washington DC.   *
In the event reasonable attempts to contact me or other parent, have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by a physician or dentist and/or the transfer of my child to any hospital that is reasonably accessible both to, from, and in Washington DC.  This authorization does not cover major surgery unless the medical opinion of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained before the surgery is performed.  
Part B. 2. Facts concerning the child’s medical history including allergies, medications being taken, and physical impairments to which a physician would need to be made aware should be outlined below:
List relevant medical information.
Part C: I understand that if my child acts in a manner which causes him/her to be sent home from the trip, I/We will come pick him/her up. *
I understand I am solely responsible for my child’s transportation home, and/or any cost of such transportation home, in the event he/she engages in behavior that could result in possible suspension/expulsion as written in the Olmsted Falls Middle School Handbook.  Such offenses include, but are not limited to:  Destruction of property, gross insubordination to any adult, harassment of another individual, not adhering to any expected behaviors of an Olmsted Falls Middle School Student as described in the Student Handbook.   We ask that you speak to your child regarding this policy and indicate below that you will  accept responsibility for his/her behavior by adhering to the removal request should it be deemed necessary.
D: In case your child needs Tylenol (Acetaminophen) but did not bring it from home, the school will provide, for this field trip only, Tylenol in pill form (no liquids available). *
I give permission for my child to take Tylenol (according to bottle directions) for a headache, abnormal temperature, and/or minor discomforts.
E. 1.: My child will be bringing his/her cell phone on the trip to Washington DC. *
I understand the following cell phone use guidelines and further understand what the consequences will be if my child does not follow the guidelines as outlined: 1. My child will not use his/her cell phone while any adult is presenting/addressing him/her while in a group setting or individually while on this trip. 2. My child will not use (text, call, message, game, access the Internet, and any other such related actions) his/her cell phone in any manner which brings intended or unintended harm on another student in our group or with any other student or group while we are on this trip. 3. My child understands that if his/her cell phone is taken by an adult on the trip that he/she will not receive his/her cell phone back until he/she serves a two-hour Saturday Detention from 8:00-10:00 AM on Saturday, April 22, 2017. 4. The Saturday Detention will cause the student to earn 3 points towards the trip to Cedar Point. 5. At 5 points, the student would lose the trip to Cedar Point. 6. We understand that if my child takes his/her cell phone on this trip without replying "Yes" in this section (E), he/she will lose the trip to Cedar Point, which will be held on Friday, May 19, 2017. 7. I understand that Olmsted Falls Middle School or any other adult associated with this trip is not responsible for any loss, damage, or theft of my child’s cell phone. 8. I understand that my child is responsible for the care of his/her cell phone. 9. I understand that use of a cell phone in an inappropriate manner as it relates to our Board adopted Student Code of Conduct may also result in additional discipline, up to and including, Office Detention, Saturday Detention, Out of School Suspension, and Expulsion from School.
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