Manchester Craftsmen's Guild (MCG) Summer 2018 Application
Fulfillment of this form does not guarantee acceptance into MCG's Summer Program. Enrollment is on a first-come-first-served basis and each session is limited to retain teaching quality and access to materials. Accepted students will be notified via email starting the week of May 7, 2018. If accepted students do not return date confirmation or payment (if applicable), waitlisted students will be accepted in their stead starting June 1, 2018.
Email address *
Student's Legal Name (First and Last) *
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Student's Preferred Name
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Birthdate *
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School attending 2018-19 school year *
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Grade for 2018-19 school year *
Student's Gender Identity *
Student's Phone number *
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Email *
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Street Address *
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City, State, Zip Address *
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Ethnicity
What sessions would the student like to attend? *
Required
Parent/Guardian's Name *
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Parent/Guardian's Primary Phone Number *
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Parent/Guardian's Secondary Phone Number *
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Student's dietary restrictions *
Student's Physician Information (in case of emergency) *
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Emergency Contact information, if Parent/Guardian cannot be reached *
Your answer
Student's allergies *
Required
Medical Waiver
I understand that Manchester Craftsmen’s Guild does not have medical professionals on staff, and that MCG teachers or other staff will not administer or provide any medication to my child. I accept that in the event of an incident with my child, MCG will make every effort to get in touch with the parent/guardian and then the emergency contact listed within. If neither can be reached and/or immediate emergency action must be taken, I hereby authorize MCG to secure all proper and required treatment deemed necessary under the then-existing circumstances to stabilize my child until such time as I can be reached to personally grant consent. I understand that the information provided on this form will only be used as needed in the event of an emergency, that it is my responsibility to notify MCG of any changes to the information provided, and that my failure to return a signed copy assumes consent.
General Program Waiver
I give my student permission to participate in MCG Youth & Arts programs. I understand that my student may be working with mechanical equipment and/or chemicals as part of their coursework in ceramics, photography, digital and design arts. I understand that MCG will share its Honor Code with my student and that any violations will be documented and suspension may result if they consistently fails to comply with this code of conduct and the rules of the MCG program. (The Honor Code can be found at www.mcgyouthandarts.org/honorcode) I understand that MCG maintains an attendance policy that expects students to communicate absences to their instructors. If a student misses 3 consecutive days without communicating with MCG they will most likely be withdrawn from the class. I understand that MCG reserves the right to cancel classes as needed due to inclement weather, or other circumstances that may put the safety of students and staff at risk. MCG will make every effort to communicate closings by posting information on our website and through inclement weather updates with local news channels. I understand that MCG provides each student a photo ID, which is required to obtain entry into the facility. A lost ID will be replaced at no cost one time only; the student is expected to pay $5 for each subsequent replacement. I understand that Manchester Craftsmen’s Guild cannot be responsible for any of my student’s personal possessions that they choose to bring to MCG programs. I understand that while at MCG my student will not view or download pornographic, racist, sexist, or inappropriate materials from the Internet.9. I authorize and release the School District of Pittsburgh to provide information concerning the education of my student to MCG. I further authorize the School District of Pittsburgh to release educational records of my student to MCG including attendance, discipline, grades, 4sight and test scores. This Authorization and Release shall remain in effect for one calendar year from the date of my signature. I understand MCG often arranges field trips for students as part of their class experience. These trips involve traveling outside the MCG facility in MCG 12 to 15 passenger vans that are driven by MCG staff. These trips may take place outside of normal program hours. All trips will be supervised by MCG staff. Special information including permission slips will be administered for extended trips. I understand that photographs and video may be taken during MCG programming, and I understand that these media are important for educational, funding and promotional materials that celebrate and share accomplishments at MCG. Therefore, I give Manchester Craftsmen’s Guild and partnering organizations my permission to use, in part or whole, the name, picture, performance, photograph and/or taped voice of my student and I release the program from any monetary compensation or from any and all claims resulting from such use. I acknowledge that MCG will make every effort to send, but does not guarantee, special notification when the images are intended for use by another organization or institution. I understand that in order to learn how well this program is working and to make improvements, MCG staff and/or professional evaluators will conduct interviews, lead focus groups and administer questionnaires in which your student’s demographic information as well as school attendance data, grades, and test scores may be included. All information will be treated confidentially and students’ names will not be revealed when results are reported.
TRANSGENDER AND GENDER EXPANSIVE STUDENT POLICY
MCG makes every effort to be open and welcoming to all students. Below are our updated policies, based on Pittsburgh Public School’s Transgender and Gender Expansive Policy from June 2016. Privacy and Confidentiality: All students have a right to privacy and this right includes the right to keep one’s transgender status private at MCG. Information about a student’s transgender status, legal name, or sex assigned at birth may also constitute confidential protected health information. Disclosing this information to other students, their parents/guardians, or other third parties may violate privacy laws, such as the Family Educational Rights and Privacy Act (FERPA). MCG shall ensure that protected health information and education records relating to transgender and gender expansive students shall be kept confidential in accordance with applicable state and federal privacy laws. Transgender and gender expansive students have the right to discuss and express their gender identity and expression openly and to decide when, with whom, and how much to share private information. The fact that a student chooses to disclose his or her transgender status to MCG staff or other students does not authorize MCG staff to re-disclose that information. To ensure the safety and well-being of the student, MCG personnel should not disclose a student’s transgender status to others, including the student’s parents/guardians or other MCG personnel, unless: (1) legally required to do so, or (2) the student has authorized such disclosure. When contacting the parent or guardian of a transgender student, MCG staff will use the student’s legal name and the pronoun corresponding to the student’s sex assigned at birth unless the student, parent, or guardian has specified otherwise. (See “Student Transitions” below.) Names and Pronouns: Every student has the right to be addressed by a name and pronoun that corresponds to the student’s gender identity. A court-ordered name or gender change is not required, and the student need not change his or her official records. MCG staff will privately ask transgender or gender expansive students at the beginning of each term how they want to be addressed in class, in correspondence to the home, or at conferences with the student’s guardian. Student Records: MCG is required to maintain a mandatory permanent student record that includes a student’s legal name and legal gender. However, to the extent that MCG is not legally required to use a student’s legal name and gender on other school records or documents, such as school IDs and classroom rosters, MCG will use the name and gender preferred by the student. MCG will change a student’s official record to reflect a change in legal name or gender upon receipt of documentation that such change has been made pursuant to a court order, or through amendment of state or federally-issued identification. In situations where MCG staff are required by law to use or to report a transgender student’s legal name or gender, such as for purposes of data reporting, MCG staff shall adopt practices to avoid the inadvertent disclosure of such confidential information. Medical Treatments or Procedures: Some, but not all transgender youth choose medical treatments to assist their transition. Treatments such as hormone therapy may be unaffordable, not medically indicated or contraindicated for many youth. Surgical treatments are generally not available for school-age transgender youth. With this in mind, MCG staff should not require proof of medical treatments as prerequisite for respecting the student’s gender identity or expression. If any objective basis should occur that would justify questioning whether a student’s asserted gender identity or expression is genuine, information may be requested to show that the gender identity or expression is sincerely held. No particular type of information (such as medical history information) should be specifically required. Sex-Specific Facilities: With respect to all restrooms or overnight facilities, MCG students shall have access to facilities that correspond to their gender identity. In any gender-segregated facility, any student who is uncomfortable using a shared facility, regardless of the reason, shall, upon the student’s request, be provided with a safe and non-stigmatizing alternative. No student shall be required to use an alternative restroom or changing facility because they are transgender or gender expansive. Under no circumstance should any student be required to use sex-segregated facilities that are inconsistent with their gender identity. MCG staff who are responsible for supervising student activity in sex-specific facilities are directed to closely monitor such facilities when being used by an identified transgender or gender expansive student in order to foster student safety. Other Gender-Based Activities, Rules, Policies and Practices: As a general rule, in any other circumstance where students are separated by gender, for instance at day or overnight field trips, each student should be permitted to participate in a manner consistent with their gender identity. Training and Professional Development: MCG’s Vice President shall ensure that training is provided for all staff members interacting with the students on their responsibilities under applicable laws and this policy. Information regarding this policy shall be incorporated into training for new employees. MCG shall implement ongoing professional development to build the skills of all staff members to prevent, identify, and respond to bullying, harassment and discrimination.
By digitally signing below, I acknowledge that I have read and consent to the terms outlined within. This includes consent for emergency medical treatment.
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Current Date *
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