I hereby give my consent for _________________________ to participate in Denny International Middle School's OST/CLC Programs being cosponsored by the Seattle Public Schools and the Seattle Department of Parks and Recreation. I will not hold the City of Seattle, the Department of Parks and Recreation, the Department employees, the Seattle School District and employees, or any other volunteer or staff associated with the above listed program responsible for any injuries, damage, or personal loss incurred while participating in the OST/CLC activities. I give permission to the Seattle School District and/or the City of Seattle to use photographs or the name of my student in its public displays or media releases. I understand that these photographs will not be sold or used for commercial purposes. I have discussed appropriate behavior with my child and I understand that my child must follow all school rules while in the program, as well as on the bus, or he/she will face discipline under normal school policy.
STUDENTS WILL NOT BE ALLOWED TO LEAVE SCHOOL GROUNDS AND RETURN TO TAKE THE BUS FOR ANY REASON. OST/CLC IS AN ADULT SUPERVISED PROGRAM. PLEASE PROVIDE STUDENT ID# TO ASSURE THOROUGH AND ACCURATE ACCOUNTABILITY.
_____________________________________________________ _______________
Parent/Guardian SignatureDate
_____________________________________________________ ________________ ____________________
Child's SignatureDateSTUDENT ID#
How will your child need to get home? (check one) ____ Walk ____ Activity Bus ____ Metro ____ Parent Pick-Up
Students who require Activity Bus home will be delivered to major points in West Seattle, Beacon Hill and Rainier Valley by a chartered school bus on Monday through Friday only as part of this program. Please only select ONE PROGRAM PER DAY. Descriptions of the programs listed below are on the back of this form.PLEASE take note to the start dates of these programs!
FALL ’09 SESSION OST/CLC PROGRAMS, 2:45pm-4:45pm
Monday Tuesday Wednesday Thursday Friday
____Homework Club ____Homework Club ____Graffiti Art ____Papier Mache ____Chess Club
____READ My Mind ____READ My Mind ____Mariachi Band ____Orienteering ____Guitar Heroes
____Jazz Band ____Girls Rap ____Cartooning ____Mariachi Band
____Jewelry Making ____Break Dancing ____C.L.C. Music Ensemble
____Jazz Band ____Hip Hop Dance ____DRAMAtized
____Guitar Heroes ____Jazz Band ____Middle Eastern Cooking ____Money-Wise
____Basketball Skills/Drills
FALL ’09 Programs will NOT operate on the following dates: 10/9, 10/28, 11/25. ALL FALL PROGRAMS END on December 11, 2009.
FALL ’09 SPORTS (OST Form and Physical REQUIRED)
If you’re signing up for a Fall ’09 Sport, write in the sport below:
FALL ’09 SPORT(s): ____________________________________ ____ Soccer Skills/Drills (Starts in Nov/Dec) -day to be announced-
IN ORDER FOR YOUR CHILD TO STAY THIS PORTION MUST BE FILLED OUT COMPLETELY. THANK YOU!
STUDENT”S PERSONAL INFORMATION:
Current Address___________________________________________________ Seattle , WA Zip__________Home Room_________
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PARENT/GUARDIAN INFORMATION:
Last Name____________________ First Name_____________________ Relationship____________________
Home Phone_________________ Work Phone_________________ Cell Phone__________________ Email________________________
EMERGENCY CONTACTS:
List eligible contacts that can ALWAYS be reached between 2:45pm and 5:30pm at the following number(s):
Parent/ Guardian Name#1 ______________________________Parent/Guardian Name #2______________________________
Home Phone _____________________Home Phone____________________Cell Phone_______________________Cell Phone______________________
Work#___________________________Work#__________________________