After School Activity Permission Slip
I give my child ______permission
(Student name)
to participate in the Oxford Middle School After-School Drama Club Program. I understand the club will meet on the days and times as indicated by Ms. Hill or on the school calendar. Clubs will not meet when school is not in session.
Club/Intramural Rules:
1. Only students attending OxfordMiddle School can participate in a club(s).
2. There is a minimal fee for the drama club of $15.00; however, the club may also hold fundraisers in order to pay for expenses accrued by productions.
3. Participation in club rules:
• GRADES:
? Student must maintain an overall 70% or above average. Students receiving grades below this requirement during grade checks will not be permitted to participate in the OMS Drama Club. Grade checks will occur each time students are participating in a “qualifying event,” ie competitions, tournaments, or presentations where students are representing OMS in the community.
• BEHAVIOR:
? Discipline will be reviewed on a case-by-case basis; however, students who receive Class 2 or above In School Suspensions or ANY out-of-school suspensions will not be permitted to participate in the OMS Drama Club.
? As the Drama Club Sponsor, I reserve the right to determine, on a case by case basis, whether a student may be dismissed from the Drama Club
• ATTENDANCE:
?Once a student has 2 unexcused absences from Drama Club meetings, the sponsor may choose to dismiss the student from participation in the club. Rehearsals will be mandatory! Unexcused absences will not be permitted.
Please check type of transportation:
_____Walker
_____Parent Pick up
My child may also ride home with: ______(no deviations without written instructions)
Student Address and Parent Contact information:
Student Name:______
Student Gender (circle one): Male Female Student Age: ______
Student DOB: ______
Student Grade: ______
Student Allergies:______
Current Medications: ______
Student Special Needs or Concerns: ______
Parent Name: ______
Parent phone: (Home)______(Work)______
(Cell)______
Emergency Contact Name: ______
Emergency Contact # ______
E-mail (work) :______
E-mail (home): ______
Video Permission Slip: Drama Club participants may view movie scene(s) in order to improve their performance. Please check below regarding video permission:
______My child may watch PG rated movies
______My child may NOTwatch PG rated movies
Picture/Video Authorization:
During the course of the year, we will be taking pictures and/or videos of our students. We will be making a scrap book with these pictures and may be sending some to the newspaper and some may be included on our web page. We would like your permission to include your child.
I, ______, the lawful parent or guardian of ______give my permission to release any pictures taken of the above mentioned child, by the club volunteers to be included in any announcements, advertisements, and documents in the WCMS name.
AUTHORIZATION AND CONSENT TO EMERGENCY MEDICAL TREATMENT
I, ______the lawful parent or guardian of ______, A minor child of whom I have custody and control, do hereby authorize the agents and employees of the Oxford City Board of Education to procure such emergency medical treatment as may be reasonably necessary to provide for the health and well being of said minor child at any time that such minor is in the custody of said Oxford City Board of Education employee while in attendance at school, in attendance at the OMS Drama club, or while en route to or from a school.
I further authorize the said agents or employees of the Oxford City Board of Education to sign any and all consents required by physicians or hospitals in connection with said emergency treatment, including but not limited to the administration of anesthesia, disposal of tissue, the taking of photographs, moving pictures, television pictures, etc, the drawing of blood samples, and the performance of such additional operations or procedures as are considered necessary or desirable in the judgment of the attending physician or hospital authorities.
In connection herewith, the Oxford City Board of Education agrees that it will direct its agents and employees to make a reasonable attempt to contact the parent or guardian of the child if emergency medical care or treatment is necessary and that the above authorization and consent is for the purpose of providing emergency care and treatment for the child when the parent or guardian cannot be located.
______
Signature of Parent/GuardianDate
Other person to be notified:
Name______Phone______
*Local phone # for emergency, please.
Date of last Tetanus Booster Shot: ______
Insurance Carrier: ______Policy #______
Doctor ______Phone # ______
Hospital______
______
(Parent/Guardian Signature)
****Please return the completed form to Ms. Natalie Hill (Drama Club Sponsor) at OMS or the OMS front office*********
For more information email Ms. Hill at