REACH!, Hardwick Trails, & Hardwick Recreation Committee X-Country Ski Program Registration

NEW day of the week this year!

Please read carefully. Now on Mondays!

Starting in Jan. we will be having the x-country ski program

after school until 5:00.

Students (grades 1-6) will ride the bus up to Hazen, have a snack and pick up will be at the cabin behind Hazen at 5:00.

There are skis and boots for the students to borrow.

Please fill out this form and return ASAP.

This is a FREE program thanks to the Hardwick Trails & Hardwick Recreation Committee.

 ***Please make sure your child is dressed for cold, wet weather.

***Please send extra gloves and socks !

Hardwick Elementary School REACH!

Registration ~ X-Country Ski Program ~ Due: ASAP ~ Space is limited ~

PLEASE PRINT CLEARLY

Student’s name_________________________________Grade__________ Teacher_____________________ Date of Birth________

 I give permission for photo/video of my child to be used in REACH slideshows, publications, local newspaper, HES website,REACH! Facebook and bulletin boards.   Yes _____     No  _____

 Parent/Guardian_______________________________ Phone 2:30-5_______________ Home ph____________ Work ph____________

 Parent/Guardian_______________________________ Phone 2:30-5_______________ Home ph____________ Work ph____________

 Emergency Contact_____________________________ Phone 2:30-5_______________ Home ph____________ Work ph____________

Please provide your email or cell phone to get REACH! Updates. _____________________________

  • via text, text @hesreach to 81010. You can opt out of messages at anytime by replying, 'unsubscribe @hesreach'. 
  • via email, send an email to hesreach@mail.remind.com. To unsubscribe, reply with 'unsubscribe' in the subject line.

Does this student have any brothers or sisters that are also signed up for the program? If yes, please list them: ______________________

Please fill out a separate form for each child.

How do you plan for your child to get home? (circle)      Walk                 Picked up by you                 Picked up by another adult (over 18)

If another adult, please give permission to the following people to pick up your child from the After School program:

Name___________________________________ Relationship__________________________ phone 2:30-5___________________

Name___________________________________ Relationship__________________________ phone 2:30-5___________________

Medical Information * Please fill this section out completely. * (circle no or yes)

*Does your child have any existing medical conditions?         NO         YES         explain_______________________________________

    *Does your child have any existing allergies?         NO         YES         explain_____________________________________________

If YES, do these allergies require the possible use of an EPI Pen or other specific medications?         NO         YES

    explain__________________________________________________________________________________________

IF YES, YOU ARE REQUIRED TO PROVIDE REACH! WITH AN EPI PEN AND/OR ANY OTHER NECESSARY MEDICATIONS

THAT CAN BE USED FOR YOUR CHILD DURING AFTER SCHOOL HOURS IN THE EVENT OF AN ALLERGIC REACTION.

*Does your child receive special education services?         NO         YES         explain______________________________________________

*Does your child have an Individualized Behavior Plan/Individual Education Plan?         NO         YES         explain _______________________

__________________________________________________________________________________________________________________________

REACH! and its employees will exercise reasonable judgment and care in the planning and operation of its trips and/or programs. I understand and agree that neither REACH! nor its employees will be liable for injuries resulting from accidents or unanticipated occurrences beyond their control. I also understand and accept that volunteers, including other parents, as well as other members of the community assist in operating these trips and programs.

In case of illness or accident, I request that REACH! contact me. If I cannot be reached or the emergency contact person cannot be reached at the phone numbers I have provided, I authorize and direct REACH! personnel to seek emergency medical care or take other action they believe is necessary under the circumstances to protect the best interest of my child/ward. If my child/ward is taken for emergency medical treatment, I hereby authorize the attending physician to administer the emergency treatment he/she believes is appropriate, and I agree to pay any resulting expense.

I have read the above form and my signature below demonstrates that I have provided my consent for my child/ward to participate in the trips/programs under the terms described above.

PARENT/GUARDIAN SIGNATURE __________________________________ DATE ________________

PARENT/GUARDIAN (please print)__________________________________ DATE _______________

In order to save paper we have put our REACH! Family handbook on our website at http://www.hardwick.ossu.org/reach for you to read. Please read it and let Erica Baker know if you have any questions.

_____ Check here if you would like a paper copy of the REACH! Family Handbook.