D.E.E.R. Chaperone form

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If you are interested in chaperoning the D.E.E.R. field trip to camp Kenbrook the week of May 20-24 please complete the following questions and then hit the submit button at the end of the list of questions (Scroll to the top of the following screen to be sure your application has been successfully submitted). Students will participate in the experience by homeroom May 20-22 homerooms; Delaney, Gorman, Latimer, Mack-Hoover, Smith, and Warfel, or May 22-24; Bell, Hugendubler, Masse, Ogle, Pegher, and Rehn. Chaperone selections will be made by late December and selected chaperones will be notified by the email provided below.

Your child's name

ex. Last, First. ex. Smith, John

Your child's homeroom teacher *

Mrs. Bell

Mrs. Delaney

Mrs. Gorman

Mr. Hugendubler

Mrs. Latimer

Ms. Mack - Hoover

Miss Masse

Mr. Ogle

Mrs. Pegher

Mr. Rehn

Mrs. Smith

Mr. Warfel

Parent volunteer's name *

Last, First ex. Smith, John

Relationship to the child *

Mother

Father

Home phone number *

ex. (717)-531-6666

Cell phone number *

ex. (717)-531-6666

Email Address *

This is how you will receive all DEER information, so please use an email address that you check on a regular basis.

I am willing to stay for the entire 2 1/2 day trip *

Yes

Required

I have the following clearances on file with the district *

Volunteer Registration Form

Child Abuse History Check

PA Criminal Record

FBI Fingerprint Check

Mandated Reporter Training Certificate

TB Test

None of the above

Required

Would you be willing to serve as a paid medical professional for the two and a half day trip? *

Yes

Not a medical professional

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