DUE BY September 7, 2018 to your teacher! PERFORMING ARTS CALIFORNIA TRIP STUDENT COMMITMENT CONTRACT

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1 DUE BY September 7, 2018 to your teacher! PERFORMING ARTS CALIFORNIA TRIP STUDENT COMMITMENT CONTRACT STUDENT NAME: YES, we are committed to having the above named student participate in the Aprende Middle School Performing Arts Trip to Anaheim, California. We have read the parent information packet. We understand the responsibility of having good academic, attendance and behavioral standing in all Aprende classes to participate in this trip. We understand the cost of the trip per student is $410 for students. We understand that the initial deposit of $50 is non-refundable and that no tax credit payments can be refunded. We agree to support Aprende Field Trip policies and procedures outlined in this packet. We also understand that the Kyrene District Code of Conduct and rules for dress and behavior as outlined in the Aprende Middle School Handbook apply to this field trip. We understand that the standards of conduct set by Disneyland for park dress and behavior will be strictly adhered to. We understand that any severe violation of behavior and safety rules on this trip will result in the above named student being flown back to Phoenix at our expense. We also understand that students must be academically and socially eligible in order to travel on the California tour. Students who do not maintain C s or higher in all classes, and B s or higher in their performing arts class, or any students with behavior concerns in any class on campus, on a school bus, or on a field trip, may be ineligible to travel to California. Any student with 3 or more absences after January 9 th may be ineligible to travel, as determined by their teacher or AMS administration. We agree to support these policies. NO, this student will not be participating in this field trip. We understand that alternative class work will be provided on any school days that the class is away from Aprende. Parent name printed: Parent Signature: Date Student T-shirt Size (adult sizes): Small Medium Large XLarge XXLarge I am interested in being considered as a chaperone for this trip. I understand that chaperones must be in good health, must be able to do extensive traveling in the parks, and must travel with the group to and from California. I understand that the chaperone fee is $350, which covers the cost of the bus, hotel, park entrances and fees. I have read the chaperone guidelines in this packet, and agree to follow procedures and rules. Chaperone name: Relationship to student: Cell Phone: Chaperone T-shirt Size (adult sizes): Small Medium Large XLarge XXLarge

2 KYRENE SCHOOL DISTRICT No. 28 FIELD TRIP PERMISSION FORM STUDENT NAME: To the parent/guardian of students in the Band, Chorus, Theater, and Orchestra at Aprende MS: The Performing Arts Department is planning a field trip to Anaheim, California on January 17-19, 2019 from 11:45 AM on the 17 th to 11:00 PM on the 19 th. Transportation will be provided by charter bus. Students can begin to arrive on campus at 7:45 AM on the 17 th to drop off their luggage. They will attend their first 3 classes of the day. Parents are required to pick their child up promptly at 11:00 PM on the 19 th. The purpose of the trip is to provide students with an opportunity to perform at the nationally recognized Disneyland Performing Arts Program in Anaheim, CA. The workshops will provide all students with experience in teamwork, performance, and critique of music as we learn more about the role of the professional studio musician. This trip is in compliance with the Arizona Arts Standards and Kyrene School District music curriculum guidelines. Other information: Students with special physical needs can be accommodated. Wheelchairs are available for rental at a nominal fee at Disneyland Park. We hope to travel with a licensed nurse or doctor who will dispense medications as prescribed, and provide minimal treatment as needed. Students will be expected to do some extensive walking in Disneyland and California Adventure, to participate in all scheduled events throughout the entire trip, and to follow all rules and guidelines of the trip at all times. Payment for the trip covers the cost of the 1 workshops and/or a performance, a 2-day Parkhopper pass to Disneyland and California Adventure, a ticket to Wicked at the Pantages Theater, two hotel nights with hot breakfasts, bus transportation, and tour T-shirt. Students are responsible for paying for their own meals and souvenirs. Special clothing required includes the tour T-shirt and other school appropriate clothing. No student will be permitted to attend this trip without social and academic eligibility, written parent/guardian permission, and a completed packet of information as required. My signature below indicates my desire to have my child, accompany the Aprende Middle School Band, Chorus, Theater, and Orchestra on the field trip noted above. I realize that Kyrene School District s liability insurance covers injury only if negligence is proved against the District and that in all other circumstances, the student s insurance covers. I also understand that student disobedience to any rule will result in appropriate discipline and consequences, possibly including the loss of performance privileges or return home. Signature of Parent/Guardian Date Signed

3 Field Trip Behavior Expectations and Guidelines Print Student Name: Print Parent/Guardian Name: The Aprende Performing Arts Department Trip to California brings great opportunity for student and parent participants. However, with this opportunity comes responsibility. That responsibility includes excellent classroom and field trip behavior, learning all required content, maintaining academic and behavior eligibility, and submitting all necessary documentation within required timelines. It is important for students and parents to understand that failure to live up to these responsibilities will cause the student to lose eligibility, and participation will be forfeited. Specifically, in order for Aprende Middle School students to participate in this trip, they will act as representatives of Aprende and must make the following necessary commitments to ensure the success of the program. Please initial (both a parent and a student) after each requirement and sign at the conclusion of the form. 1. Three Strikes, You re Out Policy A rule infraction, as determined by the directors with input from the chaperone, is a strike. 1st strike: Warning, including discussion with chaperone and director (Example: Being late, using inappropriate language, wandering away from your chaperone group.) 2nd strike: Collect call home to a parent and loss of free time in park. 3rd strike: Collect call home. Student will not perform or participate in the workshops/performances. Student will walk with a designated chaperone or director. All privileges will be revoked. Three strikes may also result in the student being sent back to Phoenix, at the parent s expense. (Example: Being inside the door of the room of a student of the opposite sex, no matter what the reason.) Note: ANY rule infraction that jeopardizes the safety of the student, or the group, including line jumping (which may result in your removal from the parks by park authorities), possession of illegal items, fighting, or leaving the hotel room for non-emergency reasons at ANY time after lights out, is considered an automatic third strike. This will result in immediate parent notification and may result in the student being flown home to Phoenix at the first possible opportunity. The parent will pay all expenses incurred in such action. Student initial Parent initial 2. In order to participate on the tour, students must average at least a B in performing arts and at least a C in all other classes during the 1 st semester, and be passing all of their 3 rd quarter classes. 3. Any student who has 3 or more instances of In School Intervention (ISI) or has any out of school suspension for any reason during the year is automatically ineligible for this trip. 4. If a student cannot travel for any reason, refunds will be made according to the refund schedule in the tour packet. The first deposit of $50 is totally non-refundable, and there are no refunds given after January 1, No tax credit payments can be refunded in any situation. 5. While on the field trip, all students will stay with their assigned adult chaperones and groups as required. No one will be allowed to walk the park or leave the hotel or park area without their specific chaperone groups. Students must stay with their designated buddy. No one will be allowed to leave the group for any reason at any stop.

4 6. Female students may not be in the room of a male student for any reason. Male students may not be in the room of a female student for any reason. Students who do not follow this rule will have an immediate third strike. Severe consequences may include loss of all performance rights, being sent home to Phoenix at parents expense, and/or disciplinary action upon return to Aprende. 7. Students will attend all programmed activities and be on excellent behavior. No one is excused from attending and/or participating in performances or clinics except for extreme health reasons, verified by staff and/or directors. Being late to any appointed time requirement will result in loss of free time at the parks. 8. Students needing to use a phone to call home may use the pay phones at the parks or restaurants with chaperone supervision. There is limited access to pay phones at the hotel with chaperone supervision. Students who carry cell phones assume all liability and responsibility for long distance charges and loss. There is no long distance calling from the hotel room phones. Parents will be given an emergency contact phone number for the directors prior to the trip. 9. Students will follow all guidelines for grooming, dress and behavior as set by the director and park rules. These guidelines are specified in the Kyrene Code of Conduct and the Aprende Handbook. Appropriate dress for events will be determined by the directors, based on park rules, and will be adhered to. Flip-flops and slippers are not allowed. Inappropriate dress will result in the student being sent back to change and loss of free time in the parks. 10. Students will follow all guidelines for behavior as set by the directors and park rules. This means no line jumping, no vandalism, no theft, and no rude behavior/language. We expect to be proud of you at all times! Students will use language and behaviors that are respectful and appropriate. This includes being polite to each other, park personnel, bus drivers, and chaperones, especially while standing in Park lines. (The parks are magic because you treat them like they are. Don t spoil it for anyone else!) 11. Students will observe all hotel rules, being quiet after lights out, remaining in the room according to the time schedule, and leaving all hotel property in the room upon check-out. Any charges to the hotel room must be paid at check-out and are the responsibility of the people assigned to the room. We have read and initialed the stated rules and I (the student) agree to abide by them during the school year and on the field trip. As a parent, I understand clearly that my child may be sent home at my expense for failing to obey the required rules for safety and behavior on this trip. In this case, I understand that I would be notified and arrangements would be made for my child to return to Phoenix AT MY EXPENSE. I agree to reimburse the Aprende Band, Chorus, and Orchestra for transportation costs should my child need to be sent home. I understand that the rules and expectations are for the safety and enjoyment of everyone participating, and agree to comply fully. Parent Signature Student Signature Date Signed Date Signed

5 Aprende Middle School STUDENT EMERGENCY AND INSURANCE INFORMATION Student Legal Name: Sex: F M Date of Birth: Age on January 17, 2019 PLEASE INCLUDE AREA CODES Parent/Guardian Name: Evening phone: Cell phone: Parent Home Address: Place of Employment: Nickname: Daytime Phone: Emergency Phone: Secondary Parent/Guardian Name: Evening phone: Cell phone: Parent Home Address: Place of Employment: Daytime Phone: Emergency Phone: Alternative Emergency Contact: Relationship to student Daytime Contact phone: STUDENT HEALTH INSURANCE INFORMATION Health Insurance Company : Phone: Policy Number: Policy Holder: Is this student eligible for care with the AHCCS program? Is this student eligible for care with Indian Health Services? AHCCS# I.H.S.# Parent/Guardian Signature Date

6 Aprende Middle School EMERGENCY MEDICAL INFORMATION AND CONSENT FORM (Please print) Student s Full Name Primary Physician Dentist Phone Phone MUST BE COMPLETE OR STUDENT MAY NOT BE ALLOWED TO TRAVEL: **Date of last Tetanus shot: Drug Allergies: Allergies to insect stings, food, or plants: Does the student need an epipen or glucagons? (please circle) NO YES, for: Does this student carry an inhaler? NO YES Name of medication: What does the staff need to know about your student for his/her medical care? This student has permission to take non-aspirin acetaminophen, if needed, given by staff. YES NO IF YOU LIST ANY MEDICATION, IT MUST BE SUPPLIED BY THE PARENT AND IN THE ORIGINAL CONTAINER. If you list ibuprofen as needed for headache, for example, you must supply it or the student will not be given it. The only medication a student is allowed to carry with them is an inhaler. Staff will carry all other medications. No self-medicating is allowed. It is the student s responsibility to come to the staff member in charge at scheduled times to receive medications. MEDICATIONS TIME TO BE TAKEN DAILY OR AS NEEDED MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC CONSENT FOR EMERGENCY CARE Be it known that I, the undersigned parent or guardian of the above named student, do hereby grant unto any trip staff, emergency personnel, medical doctor, or hospital, my consent and authorization to render such aid, treatment, or care to said student as, in the judgment of said staff, emergency personnel, doctor, or hospital, may be required on an emergency basis in the event said student should be injured or stricken ill while participating in this field trip. It is hereby understood that any expenses incurred will be the responsibility of the parent or guardian. Payment of medical expenses is not a school staff, school or district responsibility and they will not be held liable for such. PARENT/GUARDIAN SIGNATURE Signed: Print Name: Dated the day of, 20. THIS FORM MUST BE COMPLETED AND STAMPED BY A NOTARY PUBLIC. Subscribed and sworn before me this day of, at,az Date Month Year City Notary Public Commission Expires