SUMMER REGISTRATION 2019
"THE ART OF ACADEMICS THROUGH NATIVE CONNECTIONS"

The Native American Summer Enrichment Program is about building cultural community and academic proficiency. The morning activities focus on literacy, math, and science. The afternoon is time to explore cultural activities such as working hand in hand with visiting artisans, including musicians, pottery makers, painters, and healthy lifestyle coaches.

This program is for Native American students entering grades 1st - 7th. Breakfast, lunch and snacks are provided. There is a suggested activity fee of $25 for SFPS students ($100 non-SFPS); scholarships are available for families with multiple children.

For more information contact:
Nancy Davis
505 467 2644
ndavis@sfps.k12.nm.us

Summer Enrichment Program Details
June 3 - June 19, 2019
Monday - Friday, 8:00am to 3:30pm
Nina Otero Community School
5901 Herrera Road
Santa Fe, NM 87507
Initial Parent/Guardian Permission:
As a parent or guardian, I hereby give my child permission to participate in the SFPS Native American Student Services Summer Enrichment Program and All Field Trips (walking or bus) associated with the program.

I agree that the SFPS Native American Student Services and Nina Otero Community School are not liable for accidents, personal injuries or loss of personal property. I also agree that the use of drugs and alcohol is prohibited.

If not already on file, I must submit a copy of my child's CIB/Tribal Enrollment (parents/guardians CIB's accepted) and complete an ED 506 FORM to the office of the Native American Student Services

Today's Date: *
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Student Information
One student per form!
Student Name (First, Last): *
Your answer
Tribal Affiliation: *
Your answer
Birthdate: *
MM
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Current School: *
Your answer
Parent/Guardian (Electronic) Signature: *
Your answer
Grade ENTERING next school year (19-20): *
School ID #:
Your answer
Does your child have an IEP?
Will your child attend K5+ Program?
Activities/Hobbies:
Your answer
Academic Needs:
Your answer
Parent/Guardian Information
Name(s) (First, Last): *
Your answer
Email:
Your answer
Phone Number (1): *
Your answer
Phone Number (2):
Your answer
Medical Service Authorization
In order to avoid difficulties in obtaining medical services for your child, should he/she be ill or be injured during program/school-sponsored activity, we ask that you give your consent for hospitalization, medical attention or surgery in the case of an emergency.

The sponsor of the activity will consent to such services on your behalf and on the behalf of the child. Family preference of doctor or hospital will be followed if possible. Should preclude this preference, your child will be transported to the nearest medical facility consistent with the existing circumstances.
I, the parent/guardian have read the above medical plan of procedures.

I hereby designate the sponsor of the activity/field trip to act on my behalf in the event of a medical emergency. He/She may authorize treatment. I hereby assume financial responsibility for hospitalization, medical attention or surgery as might be required.

Parent/Guardian (Electronic) Signature: *
Your answer
Today's Date: *
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Student Medical Information
List all medication student is currently taking:
Your answer
List all allergies to medications:
Your answer
Preferred Doctor & Phone Number:
Your answer
Preferred Hospital & Phone Number:
Your answer
Insurance Carrier
Your answer
Policy Number:
Your answer
Special medical requirements for my child:
Your answer
Allergies:
Your answer
Emergency Contact Information
Please include the contact information for an alternate emergency contact if the parent/guardian listed cannot be reached
Name (First, Last): *
Your answer
Relationship to Student: *
Your answer
Phone Number: *
Your answer
Parent/Guardian & Student Contract
I understand that attending the SFPS Summer Enrichment Program is a privilege. This program will help my child improve his/her academic skills and social skills. This program will help my child become better prepared for the next school year. I will pay the registration fee of $20 per student.

In order to get the most out of this experience, I agree to the following:

* Parent/Guardian agrees to provide transportation to and from school site (Nina Otero Community School).
* Student will be dropped off no earlier than 7:45 am and picked up no later than 4:00 pm everyday.
* Students agree to attend regularly. If student is ill, family emergency or religious/tribal reasons prevents student from getting to program, a parent/guardian will call in the absence to the school no later than 9:00am.
* Student agrees to behave appropriately and respectfully according to the Santa Fe Public School Code of Conduct. If behavior causes student's teacher to send student to the Program Director, Parent/Guardian will be called immediately. If behavior is severe, student may be dis-enrolled from the Summer Program.
* Student agrees to dress appropriately for outdoor physical activities.
* Student agrees to do his/her best work in the Summer Program and to learn something new everyday!


SFPS CODE OF CONDUCT WILL BE FOLLOWED AT ALL TIMES.

Parent/Guardian (Electronic) Signature: *
Your answer
Student (Electronic) Signature: *
Your answer
Today's Date: *
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