hosa
FUTURE HEALTH PROFESSIONALS
membership application
Chapelhillhigh school
2016-2017
hosa is a student organization whose mission is to promote career opportunities in healthcare to all people.For more information please visit
student name ______Grade: ______
address ______
STREET CITY ZIP
Student Home /Cell phone number: ______
Email Address (optional) ______
hosa – Future Health Professionals
membership includes:
local, state, and national dues,Hosa T-shirt (to be ordered after all monies have been received) the opportunity to participate in hosa field trips and hosa competitions
turn all forms inwith your $40.00 dues to Ms. Smith in room E222.
Application Deadline: Friday September 30,2016
Please circle shirt size: s m lg xl 2xl
***Please make checks payable to chapel hill high school. note permission form and drug consent form must be signed by parent/guardian.***
office use only:
date paid: ______cash Check # ______
chapel hill high school
hosa membership permission form
2016-2017
______has my permission to participate in hosa – a student lead organization. i understand that this club is an extra curricular activity. i understand that submission to testing for the presence of drugs and alcohol is a condition of participation in prvileged activities in the douglas county school system. i further understand that i will be required to provide transportation and funds for my child to participate in conferences or events outside the regular school day. these optional activities are not a requirement to be a hosa member, but they are offered. the student has to earn the privilege of attending and participating in hosa conferences.
______
parent/guardian signaturedate
______
student signature date
thank you,
sandy r. smith
hosa advisor
Grab your phones and follow the steps below to sign up for your HOSA Club messages.This is your Remind101 number I created for you to keep your personal number secret. Text the number 81010 with the message @hosaclub16
This is the unique class code that I created for HOSA Club. This can be used by students and parents.
Chapel Hill High HOSA Photo Release form
Dear Parent(s)/Guardian(s):
This is a Photo Release Form that gives permission for your child’s picture to be posted on the web or in the news to inform our community of our accomplishments. Please complete the information below.
I, (print name) ______, the parent/official guardian of (child’s name) ______, herby grant Chapel Hill High School HOSA to take and use photos and/or digital images of my child for use in news releases and/or educational materials as follows: Print, Web, and/or Electronic Publications. I agree my child’s name and identity may be revealed in descriptive text and/or commentary in connection with the image(s). I authorize the use of these images without compensation to me. All negatives, prints, digital reproductions, shall be the property of Chapel Hill High HOSA.
Student Name: ______
Address: ______
City: ______
State: ______Zip: ______
Phone Number: ______
E-mail: ______
Parent Signature: ______Date: ______
Student Signature: ______Date: ______
DOUGLAS COUNTY SCHOOL SYSTEM
***HOSA club participate***
Consent to Participation – Student Drug Testing
I understand that submission to testing for the presence of drugs and alcohol is a condition of participation in privileged activities in the Douglas County School System. I further understand that if I refuse to take the test, fail to report for the test, or if the test establishes a violation of the drug testing policy, I will be subject to consequences as set forth by the drug testing policy.
By signing and dating this form, I consent to take an initial drug test, if required, and be randomly tested throughout the school year. The initial drug test, when required, is to be completed prior to the start of the privileged activity. The random testing will be done monthly throughout the school year. The selection process for random drug testing will be performed by the contracting body with the participating students being notified on the day they are to report for testing.
I hereby consent to the administration of drug tests and to the conditions listed in this consent and the accompanying general prohibitions and procedures as outlined in Policy JCDAB-R/JCDAC-R,JCDAB-R(1) of the Douglas County School System Policy Manual.
I understand that unless my parent or guardian contacts the Drug Testing Administrator after the first year, and makes a formal request to remove my name and student ID number from the testing pool, my name will automatically be re-entered into the testing pool each year.
Participating Student’s Name:
Date: Signature:
Parent/Guardian’s Name:
Date: Signature: