YAHOOO Camp Form
As part of your education here at Regis Middle School, Sixth graders will be taking part in a two days at Camp Wapsie. Here you will take part in many activities that will help you get to know your fellow classmates better, as well as yourself. We will be leaving each morning at 8:00 on Sept. 15 and 16th. We will return each night, Thursday at 9:00 and Friday at 2:45.
Student's Last Name
Your answer
Student's First Name
Your answer
Last Name of Parent/Legal Guardian
Your answer
First Name Parent/Legal Guardian
Your answer
I give permission for my son/daughter to attend YAHOOO 2016. I understand that the group plans to go by bus. In the absence of negligence on the part of Regis Middle School, Cedar Rapids School District Transportation, or any parents furnishing supervision for this trip, the undersigned parent of the students who are participants waives any claim against Regis Middle School, Cedar Rapids School District Transportation, or any parents furnishing supervision for the trip for any damage to or of property or injury to the students.
I give permission for my son/daughter to have the following medications as needed:
Check all that apply
Required
I need my child to take the additional medicine, prescription or non, during our trip.
We dispense meds at , lunch (11:30ish) and dinner (5:30ish). If those times won't work please specify when they need to be given. Remember these are to be seen as regular school days. If your student takes any medication during school, they will be taking them at camp as well.
Please list medicine and dosages
Name of Medicine
Your answer
Dosage
Your answer
Time given
Name of additional Medicine
Your answer
Dosage
Your answer
Time Given
Name of additional Medicine
Your answer
Dosage
Your answer
Time Given
Name of additional Medicine
Your answer
Dosage
Your answer
Time Given
Name of additional Medicine
Your answer
Dosage
Your answer
Time Given
If there are any additional medicines please list below with the dosage and time given.
Your answer
Please electronically sign your name that your agree to the administration of the above medicine.
Your answer
In case of emergency please list the name and number of person to be contacted while we are at camp. This includes an overnight contact.
Please list a name and phone number for contact
Your answer
I understand that the fee for this trip is paid during E-Registrations. The cost is $55 and will need to be paid prior to my child participating.
Required
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