Creekwood Student Council Work-On Packet
Student Council Candidate Name: ______
In order for you to be considered for Creekwood Student Council, you must turn in your completed packet to the Creekwood Middle School front office by noon on August 8, 2016. Use the checklist below to ensure you have done everything to become a Student Council member for the 2016-2017 school year.
_____ Read through the orientation packet
_____ Sent your information via email to the sponsors
_____ Read the Creekwood Student Council Constitution (located on our website)
_____ Completed Constitution Signature Form
_____ Completed Medical Release/Information Form
_____ Completed Liability Release Form
_____ Read and signed Parent Guardian Consent
____ Read and signed Student Council Representative Contract
_____ Completed and documented 15 volunteer hours
_____ Turned-in completed Work-On Packet by noon on August 8, 2016
___ Constitution Signature Form
___ Medical Release/Information Form
___ Liability Release Form
___ Parent Guardian Consent
___ Student Council Representative Contract
___Work-On documentation
I, ______[ parent/guardian ], along with ______[ student(s) ], have read the CMS Student Council Constitution and understand the purpose of the organization along with the membership requirements and responsibilities. On this date, ______, we agree to abide by the Constitution, as made evident by our signatures.
______
Parent/Guardian signature Student signature
______
Student signature
MEDICAL RELEASE/INFORMATION
Child’s Name: ______Birth date: ______
Address: ______
Allergies: ______
______
Tetanus ______(Date of last booster)
Pediatrician: ______Phone: ______
Medical Problems: (Examples: motion sickness, stomach problems, diabetes, asthma, nosebleeds, etc.)
______
______
Do you have Hospitalization Insurance? Yes / No
Mother’s Name/Legal Guardian: ______
Home Address: ______
______
Phone Number: ______
Emergency Number: ______
Mother’s Employer: ______Phone: ______
Insurance Co.: ______Phone: ______
Policy Number: ______Social Security #: ______
Group Number: ______(if necessary)
Father’s Name/Legal Guardian: ______
Home Address: ______
______
Phone Number: ______
Emergency Number: ______
Father’s Employer: ______Phone: ______
Insurance Co.: ______Phone: ______
Policy Number: ______Social Security #: ______
Group Number: ______(if necessary)
MEDICATION(S): I have completed the additional “Medical Permission Slip” indicating any medication to be given to my child by the adult(s) in charge. I attest that the above information is correct and agree to notify sponsors of any changes in the information provided both on this and any other medical form.
______
Parent’s signature
______
Date
LIABILITY RELEASE
______has my permission to travel/participate with CMS
Student Council beginning August 2016 through August 2017. In the event of injury or
accident, I understand the Humble Independent School District, its representatives,
employees or chaperones will not be held liable.
______
Date Parent’s signature
Please complete:
Parent’s Name: ______
Address: ______
______
Phone Number: ______
Email address: ______
Emergency Contacts:
Name: ______
Phone: ______
Name: ______
Phone: ______
Name: ______
Phone: ______
CMS STUDENT COUNCIL REPRESENTATIVE
Parent/Guardian Consent
2016-2017
PLEASE PRINT THE INFORMATION BELOW
Name of Candidate: ______
Parent/Guardian Name: ______
I understand and support my student in their choice to be a part of Student council. I have discussed this with my child and we both understand the responsibilities of the position.
– As a Student Council Representative, my child will be asked to set the example for other students to follow.
– A requirement for being a representative is maintaining good grades, and I understand that my student will seek help in classes which their grades drop.
– I understand that this is a year-long commitment. I will be supportive of my student throughout the school year.
– I have also discussed the time requirements of a Student Council representative with my child, and I understand there will be weekly meetings, weekend and summer activities, overnight trips, and other activities that may be required of a representative. In some instances, students will have to prioritize activities they are involved in. If a student does not feel they are able to commit to the amount of time required to make our Council function efficiently, it is the student’s responsibility to discuss their role on Council with one of the sponsors.
– I understand the time requirement of my student as well as myself in regards to transporting my student to and from events and helping chaperone events when needed.
– Each month students will receive important dates that will be written into a calendar so they are aware of upcoming events. I understand that excessive Council absences may result in removal from their position.
– I will support the CMS Student Council, sponsors, and students in the organization. I will not use their participation as a disciplinary tool since this can affect not only my student, but up to 30 others as well. CMS Student Council does not intend to intervene in family concerns, this is your right as a parent/guardian, but our hopes are that the family will consider their student’s impact on the entire organization. All Officers/Delegates/Representatives are important, regardless of position.
– I understand that the sponsors want to keep an open line of communication with the families of Council, and I will receive many permission slips to sign and information packets about Council activities.
– I pledge to support my student in this endeavor and encourage them to discuss any concerns they may have with one of the sponsors.
I agree to the above and give my student permission to a Student Council Representative for the 16-17 school year.
Parent/Guardian Signature: ______Date: ______
CMS STUDENT COUNCIL REPRESENTATIVE CONTRACT
2016-2017
PLEASE PRINT THE INFORMATION BELOW
Name: ______Grade 16-17: ______
– I have given serious thought about seeking a representative position and understand the commitment I am making.
– I have discussed this with my parents and explained to them the amount of time and effort that accompanies this position.
– I understand that I will be asked to devote a large amount of my time to CMS and Student Council.
– I understand that dates for major events and meetings the council will be involved in will be given to me as soon as possible. Excessive absences from Council activities may result in removal from my position if I am elected.
– I have read and understand the Student Council Constitution.
– I understand that I must be eligible in order to participate in the majority of Council events. If I do not meet eligibility requirements set by the school district I may be asked to resign from my position.
– I understand that I will have to prioritize my time between Student Council and other activities. I will keep constant communication with the sponsors regarding conflicts that may arise.
– I understand that if I am not able to fulfill my duties as a representative, I will be asked to resign my position.
– I understand that as a Student Council Representative, I will be expected to set the example for Council members and other students to follow.
I fully accept the duties of my position. I promise to fulfill the responsibilities of a Student Council Representative.
Signature: ______Date: ______