Dr. A. B. Consentino School
Welcome to Dr. A. B. Consentino School
Home of the Chargers
Consentino students in grades 3-8 will be taking the computer-based PARCC test during March 16-April 17. Teachers have provided students training with regard to navigating the computer based test on the TestNav 8 platform. Please click here if you’d like to review part of the interactive training that all students have received in school.
Weekly Parent Update 4/18/15
I hope this email finds you and your families well on this beautiful Saturday morning. PBA PARCC testing has concluded. The EOY PARCC testing will begin in the first week of May. I want to thank Dr. Thakkar and the teachers for their hard work and collaboration.
As you know, next week is April vacation. The Boston Marathon is on Monday. Mr. Jenkins (Gr. 7 math) will be running the race. Nate is an elite runner and his goal is to place in the top 20. If he achieves this goal, he will qualify for the Olympics. Good luck to Mr. Jenkins. His number is 38 and he will be wearing green and black.
Below are some important reminders/events:
• April 27-May 1- Spirit week at Consentino.
Monday – Sports Day
Tuesday – Superhero Day
Wednesday – Neon Day
Thursday – Black and Gold/Charger Day
Friday – Color War!!!
K-4 ~ Purple
5th ~ Red
6th ~ Orange
7th ~ Green
8th ~ Blue
Friday we will also be having the Student/Faculty Volleyball game!!! The game will be held at 1:15 in our gym. Parents are invited to attend.
5th Grade MCAS Science – May 11and May 12
8th Grade MCAS Science – May 13and May 14
Please contact the office if you have any questions.
Thank you again for all your support. I am truly blessed to have the best students, parents, and staff in the city. Enjoy these precious days off with your families.
Classical Academy Meeting on 4/15/15
Good Morning Gr. 8 Parents,
Just a reminder that the Classical Academy meeting is tonight at HHS at 6:00 pm in the auditorium. Have a good day.
Weekly Parent Update 4/11/15
I hope this email finds you and your families well on this beautiful Saturday morning. It looks like spring has sprung. This has been a very busy week at school. The kiddos and teachers have been working extremely hard with PARCC testing. I want to thank Dr. Thakkar for all his hard work coordinating this endeavor. This is the last week of the first round of testing, and it has gone smoothly thanks to our phenomenal staff and students.
Below are some important events/reminders:
• April 11- Volleyball championship tournament @HHS. Boys play at 11:40 and girls play @ 12:30. Good luck to our student/athletes. I want to thank Mr. East for taking the time to help coach the kids the past few weeks.
• April 16- Rich Barnes will be speaking to our 7th grade students about the dangers of drug addiction at 10:00 in the cafeteria. If you have any questions, please call or email me.
• April 20-24- Spring recess- No school.
• Beginning Monday, please drop off your K-4 students in the back of the school in the morning. The snow is finally melting, and we will not be having our little ones sit in the gym from 8:05-8:25. They will line up outside and wait for their teachers to pick them up to enter the building.
• Haverhill Foundation for Excellence in Education is holding a Trivia Night. This will be held on May 9 at the Roma. Details are available on the website www.haverhilleducationfoundation.org
• Our office hours are 8:00 am to 3:45 pm. Please call between those hours to schedule appointments.
Thank you again for all your support. I am blessed to have the best parents, children, and staff in the city. If you have any questions or concerns, please feel free to email me at email@example.com or call the office to schedule an appointment. Enjoy the weekend with your families.
Weekly Parent Update 4/4/15
I hope this email finds you and your families well on this Easter weekend. This has been a very busy week at school. I want to thank all the parents who came to conferences on Thursday night for your continued support. If you need to speak with your child’s teacher further, please call my secretaries to make an appointment.
I want to congratulate our Consentino/Silver Hill Junior Academic Bowl team. Last Wednesday night, they won the city championship in sudden death vs. Sacred Heart. We are extremely proud of our kiddos and coaches. Ms. Shepherd and I are hosting a victory celebration on Tuesday afternoon at Silver Hill to honor the children.
Below are some important events/reminders:
• Applications for the new Haverhill High School STEM Academy Information Technology Pathway are due this Monday, April 6. Please turn completed applications in to Room 8/Guidance. This National Academy Foundation IT Pathway Class of 2019 is limited to 24 freshmen, so don’t delay! Please note that only the IT Pathway requires an application at this point. Other STEM Pathways may be declared during a student’s freshman year. Visit hhs.haverhill-ps.org/stem-academy for more about the IT Pathway and other STEM Pathway options. Learn more about the National Academy Foundation at www.NAF.org.
Students enrolled in Discovery Club are engaged in a Service-Learning Project and have been working hard to make some changes to our school library. Students are currently hosting a book drive in the community and at our school. If you have books to donate, please bring them into school. There is a collection box just inside the front door. We need fiction and non-fiction for grades K-8. Please join me in thanking the students of Discovery Club for their efforts which will benefit all students at Consentino!
The Haverhill Foundation for Excellence in Education is currently raising money to help us with new book purchases. So far, they have raised $1,000.00!!
If you have any questions, please contact the Discovery Club program Assistant Director, Karen Ehresman. Email: firstname.lastname@example.org or by phone: 978.420.01955.
• The Haverhill YMCA has great April Vacation and Summer Camp Programs for all interests! Check out the website at www.northshoreymca.org to check it out and register today!
Friday April 10th is the next PTO meeting and we’re trying something a little different. It will be a beverage/snacks, 6:30 pm, evening meeting at my house for those of us who can’t make it to the evening meetings ever. It’s a chance to relax and chat a little with friends and catch up before we all disappear for vacation.
Looking forward to my first nighttime PTO meeting. I will have snacks and beverages. If you’d like to bring a small snack to share or something to drink that would be appreciated too!
Friday, April 10th
535 West Lowell Ave, (gray house w/long driveway and shamrocks on windows)
If you have any questions please email me Julie Dellea: email@example.com
• Wolfgang Burger (Gr. 7) will be performing at the House of Blues with his band on April 21. Please see below for further information if you are interested in attending.
House of Blues – Black Diamonds at “Bringin Down The House”
• Lastly, the Essex County Sheriff’s Office is accepting applications for their popular summer camp. If you are interested in applying, please see the attachments below.
Welcome to the Essex County Sheriff’s Department 2015 – Youth Leadership Academy
will be considered incomplete and the applicant will automatically be placed on the wait list.
IMPORTANT?We will accept questions by e-mail or telephone
ALL APPLICATIONS MUST BE COMPLETE AND MAILED
NO APPLICATIONS WILL BE ACCEPTED BY FAX OR E-MAIL
PLEASE READ – NEW INFORMATION
The 2015 Youth Leadership Academy held during the summer months is free for each participant. Each applicant can apply for the week in which their city/town is listed. Applicants are placed on the active list on a “first come, first serve” basis. In the event the week for their city/town is filled, the applicant will be placed on the wait list. He/she may be given the opportunity to attend an alternate week. For all applications received by May 31, 2015, a confirmation notification or wait list notification will be sent no later than June 18, 2015. This notification will be sent via e-mail or telephone call. In the event the applicant is placed on a wait list, the parent/guardian may be contacted and given the opportunity for the applicant to attend an alternate week.
The following pages include: Academy Dates, Application, Activity Schedule, Bus Schedule, Rule and Regulations of the Academy, Waivers, Releases and other pertinent information.
For information and updates please go to: www.mass.gov/essexsheriff/
ALL APPLICATIONS ARE TO BE MAILED – DO NOT E-MAIL OR FAX
Essex County Sheriff’s Department?Attention: Youth Leadership Academy – Executive Assistant Judy Lacroix
20 Manning Avenue, Middleton, Ma 01949
Participants may attend one week only and are selected from the applications submitted and are selected on first come first serve basis
The following is the information list included in this document. Highlighted pages must be mailed. Other sheets are for your information. Please review these sheets prior to your child attending YA
Page: 1 – Welcome – New Information Page: 2 – Schedule
Page: 6 – Attendance Information?Page: 7 – Bus, Pick-up & Drop off Schedule?Page: 8 – Bus Schedule & Locations?Page: 9 – Pick up Form – Junior & Senior Academies
Signatures are required on the application and each waiver. If the signature is omitted, the application
Page: 10 – Jump-On- In Waiver – Junior Academy
Page: 11 – Ropes Waiver – Senior Academy
Page: 3 – Application
Page: 12 – Danvers Fire Department Waiver – Junior Academy
Page: 4 – Medical
Page: 13 – Rock Wall Waiver – Junior Academy
Page: 5 – Release/Waiver – Junior & Senior Academies
Page: 14 – Rock Wall Medical – Junior Academy
Page: 15 – Parent Survey
ESSEX COUNTY SHERIFF’S DEPARTMENT YOUTH LEADERSHIP ACADEMY
Thank you for choosing the Essex County Sheriff’s Department?Leadership Academy. The Academy is a non-profit educational service?designed to provide a structured youth diversion program for at risk?adolescents. There are two age groups: The Junior Academy serves ages 8 -11 and the Senior Academy serves ages 12-15. This well-structured and disciplined program will use a wide variety of game and team-building activities which will help develop teamwork and cooperation. Your child will be challenged both physically and mentally. This will help prepare the participants for the challenges of the high and low ropes course. Please be advised that some of these activities can be physically demanding. Safety is a very high priority for all participants.
Please provide all the information requested on the application. If a situation or health issue is not on the application, please provide us with that specific information pertaining to your child. If you feel your child cannot participate in certain activities please provide that information on the application or contact us prior to his/her participation at the Academy.
It is important that you read all the information that we have provided. This will help enable us to provide a creative, enjoyable and positive experience for your child.
FOR MORE INFORMATION PLEASE CALL 978-750-1900 EXT 3312 OR E-MAIL US WITH YOUR QUESTIONS AT firstname.lastname@example.org All applications must be mailed.
ALSO PLEASE REFER TO OUR WEBSITE FOR UPDATES AND CHANGES www.mass.gov/essexsheriff/community
1 – 6/29 – 7/3 2 – 7/6 – 7/10 3-7/13–7/17 4-7/20–7/24 5-7/27–7/31 6 – 8/3 – 8/7 7-8/10–8/14 8-8/17–8/21
SCHEDULE OF CITIES AND DATES
Haverhill – Salisbury – Amesbury?Danvers – Ipswich – Newburyport – Newbury – West Newbury?Lynn – Gloucester – Rockport – Essex – Manchester?Haverhill – Merrimac – Groveland – Georgetown?Lawrence – Methuen – Andover – North Andover?Middleton – Salem – Marblehead – Nahant – Swampscott?Lynn – Lynnfield – Saugus – Peabody – Topsfield – Rowley – Boxford Lawrence – Beverly – Hamilton – Wenham
The Youth Leadership Academy is funded by the Essex County Sheriff’s Department and a grant from New England High Intensity Drug Trafficking Areas “HIDTA”
THIS YEAR’S ACTIVITIES INCLUDE (not a complete list)
Rock wall – Fishing Trip – Ropes Course – Laser Quest – CPR Course – Internet Bullying Class Drug & Alcohol Awareness – MSPCA, Methuen – US Coast Guard – and other events
To enroll your child for the 2015 Youth Leadership Academy please fill out the application and mail to: Essex County Sheriff’s Department,?Attention: Youth Leadership Academy – Executive Assistant Judy Lacroix?20 Manning Avenue, Middleton, Ma 01949
For Internal Use Only Date Received______________?Active List_____ Wait List_____ Date Confirmed_________By_____ Paperwork Complete______ Paperwork Not Complete______
Allergy______ Recent Injury______ Other_______ None______ Meds______
2015 LEADERSHIP ACADEMY APPLICATION MUST BE MAILED
If mailing more than one application together, applications must be clearly separated. All sheet for one application should be stapled together. To insure siblings’ applications are not separated, mail applications in one envelope.
Participants are selected from the applications submitted and are selected on first come first serve basis
PLEASE PRINT CLEARLY
NOTE: You must apply for the city in which you reside. All information must be provided in full. If any information is omitted, your child will be placed on the wait list until all information is provided, this includes any necessary signatures and waivers. If the week is filled, the applicant will be placed on the wait list. The applicant may be given the opportunity to attend an alternate week.
PLEASE CHECK ONE OF THE FOLLOWING – One application per child ___Ages 8–11 Junior Leadership Academy?___Ages 12–15 Senior Leadership Academy
Attending week of ___________To__________Week #____City/Town_____________ Child’s Name____________________________________________________________ Date of Birth_____________________Age____________Sex: M_________F_________ Address_____________________________City_____________State______Zip_______ Parent(s)/Guardian(s) Name_________________________________________________ Primary contact number__________________Secondary number___________________ E-mail Address___________________________________________________________?If you are not available in an emergency, who should be contacted? Name___________________________________Phone Number____________________ Relationship to Child______________________________________________________ My child will be taking the bus_______Bus Location (City/Town)____________Time____ I will drop my child off at the Essex Technical High School (formerly Essex Aggie)_______
T-Shirt size: Child___or Adult___ SM___ MED___ LG___ XLG___ XXLG___
Please respond to each question fully. To avoid issues, each question must have a response. (2015)
Name of Participant_____________________________________ INSURANCE INFORMATION
Is your child covered by family medical/hospital insurance? Yes____ No____ If yes, please indicate carrier or plan name
Name of Insured________________________Relationship to Child_________________
Does your child have any current or past medical conditions that could affect his/her ability to participate in the Leadership Academy? Yes____ No____?If yes, please explain:
Is your child taking any medication(s)? Yes_____ No_____?If yes, please state what medication and the condition for which your child being treated.
Does your child have any of the following conditions?
____Recent injury?____Food Allergies?____Inhaler?____Chronic or recurring illness?If you check any of the above, please provide all additional and specific information:
Any of the above information may require further documentation or note from physician.?Any medications/epi-pens/inhalers will be held by a Sheriff’s Staff Member throughout the course of the day. Medications must be in the original prescription container with the child’s name.
Do you authorize the Sheriff’s Staff Member to assist in the administering of your child’s medication if necessary? Yes____ No____ Does not apply____
Please state the medication(s):______________________________________________ Parent/Guardian Signature_________________________________________________
____Recent Surgery ____Medication Allergy ____Epi Pen
____Asthma ____Other Allergies
Yes_____ No_____ ____Diabetes
RELEASE OF LIABILITY – ACKNOWLEDGEMENT OF RISK
I understand that I/We are voluntarily participating in the Essex County Sheriff’s Department Leadership Academy. In an effort to best serve my child, I give permission to allow the Essex County Sheriff’s Department’s Staff to speak freely with the school and any/all of the individuals named on this application who are working with my child.
WAIVER OF CLAIMS
I have been made fully aware of and understand the purpose, specific activities and risks in which my child will participate during his/her participation in the Essex County Sheriff’s Department Leadership Academy. Therefore, I hereby agree to indemnify and hold harmless, release and forever discharge the Essex County Sheriff’s Department, their employees, agents, successors and assigns from any and all manner of actions, suits, claims, demands, damages, and liability (including negligence claims) in law and in equity which may arise or result from my child’s participation in the Essex County Sheriff’s Department Leadership Academy including costs and reasonable attorney fees. The terms herein shall serve as a release not only for me but also for all members of my family. I/We assume the risk of any and all injuries that may occur during participation in the program. Moreover, I acknowledge that I have been made fully aware of and understand the Department’s procedure for administering medications to my child, if necessary, and authorize them to act accordingly and in the manner set forth in the application packet herein.
Parent/Guardian:___________________________ _____________________________ Print Name Signature
I grant to the Essex County Sheriff’s Department Leadership Academy the right to use, reproduce, assign and/or distribute photographs, films, videotapes and sound recordings of the participant for use in materials they may create.
Parent/Guardian:___________________________ _____________________________ Print Name Signature
PLEASE MAIL COMPLETED FORMS TO
Essex County Sheriff’s Department Attention: Training Department – Leadership Academy 20 Manning Avenue, Middleton, Ma 01949
Participants are selected from the applications submitted and are selected on first come first serve basis
PLEASE PRINT – SAVE & READ AGAIN PRIOR TO YOUR CHILD ATTENDING
ATTENTION: PARENT/GUARDIAN?CONTACT NUMBER 978-750-1900 EXT 3312 FOR THE FOLLOWING INFORMATION
• €If your child is placed on the active list and will not be attending please notify us immediately. ?
• €If your child is going to be absent on any day, you must leave a message by 8:30AM. If you need to contact your child while he/she is at the Academy, please call the above contact number. ?
• €No lunch is required on Friday. There will be a cookout/graduation at 12 noon at Essex Technical High School, Route 62, Danvers, MA. Parent/guardians are encouraged to attend. You may take your child home immediately following the graduation. ?
• €Sneakers are mandatory and must be worn at all times. Moreover, because of the nature of the activities, flip flops, sandals, half skirts, tank tops, short shorts, or pants below the beltline are prohibited. Please be advised that failure to comply with the foregoing may lead to your child being prohibited from participating in the day’s activities and being sent home. ?
• €Please supply your child with a water bottle and lunch every day. Snacks are also recommended. Backpack or carry bag is not necessary but recommended. Please label with your child’s name. Sunscreen and bug spray are encouraged. Please ensure your child is dressed appropriately for the weather and activities. ?
• €If any medications need to be brought to the Academy, the medication must be in the original prescription container and listed with your child’s name. If the medication was not listed on the application, the parent/guardian must supply a signed note accompanying the medication and authorizing Department Staff to administer the medication to the child. The staff member will not administer without this information. A Sheriff’s staff member will hold onto the medication. ?
• €If a child has his/her cell phone, it must be placed in their backpack/carry bag and turned off. Please be advised that the use of cell phones during the day is prohibited. Failure to adhere to the foregoing may result in the confiscation of the phone, which will be returned at the end of the day. ?
• €No child will bring drugs, alcohol, weapons, fireworks, headphones, Ipods, games, balls (of any kind), skateboards or electronic games to the Academy. ?PLEASE BE ADVISED THAT FAILURE TO ADHERE TO ANY OF THESE RULES AND REGULATIONS MAY RESULT IN YOUR CHILD BEING DISMISSED FROM THE ACADEMY AT THE DISCRETION OF THE DEPARTMENT ?
Please check the weather forecast, dress your child
appropriately. Some activities are held outdoors.
PLEASE PRINT – SAVE?READ AGAIN PRIOR TO YOUR CHILD ATTENDING
**REMEMBER TO CHECK THE WEBSITE FOR ANY CHANGES AND UPDATES ON THE BUS SCHEDULE
STUDENT PICK-UP / DROP OFF – PLEASE ABIDE BY THESE TIMES
YOUR CHILD MUST BEHAVE ON THE BUS! HORSEPLAY, FIGHTING, FOUL LANGUAGE AND OTHER FORMS OF MISCONDUCT ARE PROHIBITED AND MAY RESULT IN DISMISSAL FROM THE ACADEMY AT THE DISCRETION OF THE DEPARTMENT
**An adult must be present with the child at drop off and pick up locations. You will need to sign your child in and out.
IF TAKING THE BUS
Your child must be at the designated bus stop location on time.?In the afternoon, your child will be dropped off at the same location approximately 2:45 – 3pm. Please allow extra time for multiple bus stops.
IF DROPPING OFF AT ESSEX TECHNICAL HIGH SCHOOL (FORMERLY THE ESSEX AGGIE Rt. 62, Danvers, Ma)
Your child must be dropped off no earlier than 8AM and no later than 8:30AM at the Essex Technical High School, 562 Maple Street (Rt.62) Danvers, MA. See Youth Academy sign for parking. Your child must be checked in by a staff member.
PLEASE TAKE NOTE: CHILD MUST BE PICKED UP BY 2:30PM FROM THE ESSEX TECHNICAL HIGH SCHOOL AT THE SAME LOCATION
IF YOUR CHILD IS GOING TO BE ABSENT
Please leave a message at 978-750-1900 EXT 3312 BY 8:30AM that day.
IF YOU NEED TO REACH YOUR CHILD DURING THE DAY
Please call 978-750-1900 EXT 3312
FOR EMERGENCY USE ONLY?For emergency 24 hour calls only. Please call 978-750-1900 ext. 3302 Someone will forward the call or information to the correct person.
PLEASE VISIT OUR WEBSITE FOR INFORMATION UPDATES AND CHANGES www.mass.gov/essexsheriff/community
BUS LOCATIONS AND TIMES ARE SUBJECT TO CHANGE PLEASE CHECK THE WEBSITE THE WEEKEND PRIOR TO YOUR CHILD ATTENDING
2015 BUS SCHEDULE AND LOCATIONS?PLEASE NOTE: Please choose the best bus location for your child. Please adhere to the bus location you have chosen for the whole week. If there must be a change, please notify us as soon as possible. The first bus stop will be promptly at the time specified. PLEASE BE ON TIME. If there is a second and third bus stop for your region the times are approximate. Please be there for time specified. We have no control over traffic delays.
1 – 6/29 – 7/3 Haverhill – Salisbury – Amesbury
8:00 am – JG Whittier Middle School, 256 Concord St., Haverhill?8:15 am – Tilton School, 70 Grove St., Haverhill- parking lot across from school 8:00 am – OCC Center, 80 Elm St. (RTE 110) Salisbury, back end of parking lot
2 – 7/6 – 7/10 Danvers – Ipswich – Newburyport – Newbury – West Newbury
8:00 – am Ipswich Police Station, 15 Elm St., Ipswich?8:00 – am National Guard Armory, Low St, Newburyport (across from Middle School) Danvers – Drop child off at Essex Technical High School, Route 62
3 – 7/13 – 7/17 Lynn – Gloucester – Rockport – Essex – Manchester
8:00 am – O’Maley Middle School, 32 Cherry St., Gloucester 8:00 am – Lynn English High School, 50 Goodridge St., Lynn
4 – 7/20 – 7/24 Haverhill – Merrimac – Groveland – Georgetown
8:00 am – JG Whittier Middle School, 256 Concord St., Haverhill?8:15 am – Tilton School, 70 Grove St., Haverhill- parking lot across from school 8:00 am – Georgetown Public Library, 2 Maple St. Georgetown
5 – 7/27 – 7/31 Lawrence – Methuen – Andover – North Andover
8:00 am – Central Catholic High School, 300 Hampshire St., Lawrence?8:15 am – SLE Education Complex, 165 Crawford St., So. Lawrence?8:00 am – Merrimack College, 315 Turnpike St., North Andover (use parking lot by the Chapel)
6 – 8/3 – 8/7 Middleton – Salem – Marblehead – Nahant – Swampscott
Middleton – Drop child off at Essex Technical High School, Route 62?8:00 am – Collins Middle School, 29 Highland Ave., Salem – Powderhouse Ln., use lot near football field
7 – 8/10 – 8/14 Lynn – Lynnfield – Saugus – Peabody – Topsfield – Rowley – Boxford
8:00 am – Market Basket, 225 Nbpt Tpk, Rowley – use front end of lot closest to Rte 1 8:00 am – Lynn English High School, 50 Goodridge St., Lynn?8:15 am – Topsfield Fairgrounds, 207 Boston St., Topsfield – Parking Lot A?8:15 am – Higgins Middle School, 1 King St. Peabody
8 – 8/17 – 8/21 Lawrence – Beverly – Hamilton – Wenham
8:00 am – Briscoe Middle School, 7 Sophier Rd., Beverly?8:00 am – Central Catholic High School, 300 Hampshire St., Lawrence 8:15 am – SLE Education Complex, 165 Crawford St., So. Lawrence
PLEASE CHECK OUR WEBSITE FOR UPDATES AND CHANGES BEFORE YOUR CHILD ATTENDS THE ACADEMY
AUTHORIZED TO PICK UP FORM
Your child’s safety is a primary concern to us at the Youth Leadership Academy. Therefore, we ask that you return this form to us complete with all the names that are authorized to pick up your child.
Your child will not be released to anyone whose name is not listed below. If anyone other than the parent is picking up the child/children, a note authorizing this pick up from the parent must be given to the staff. All persons, including parent/legal guardian, will be required to present a valid driver’s license or photo identification card before the Essex County Sheriff’s Department Youth Academy Staff will release the child off the bus.
Child’s Name:_____________________________________________________________ Last First
Mother’s Name:_________________________Telephone Number____________________ Father’s Name:__________________________Telephone Number___________________
Are both parents authorized to pick up child? Yes No (circle one) If no, who is authorized to pick up your child?
Name______________________________________Telephone Number_______________ Emergency Contact?Name:________________________________Telephone Number____________________ Name(s) of other people authorized to pick up my child and relationship to my child. Name______________________Telephone_______________Relationship_____________ Name______________________Telephone_______________Relationship_____________ Name______________________Telephone_______________Relationship_____________ Name______________________Telephone_______________Relationship_____________ I authorize the above person(s) to pick up my child.
JUMP-ON-IN Waiver Form
In consideration of being allowed to enter into the play area and/or participate in any parties or programs at Jump On In, the undersigned, on his/her own behalf and on behalf of the minor(s) identified below, acknowledges, appreciates and agrees that: I willingly agree to comply with the stated and customary terms, rules and conditions for participation. In addition, if I observe any hazard during my participation, I will bring it to the attention of the nearest official immediately; and I understand that the risk of injury can be significant, including the potential for paralysis and even death, and while particular rules, equipment and personal discipline reduce the risk, the risk does exist; and I knowingly and freely assume all risks both known and unknown, even if arising from the negligence of other participants. I assume full responsibility for all participants listed below. Further, I agree to assume liability for all medical costs, attorney fees, and all other damages resulting from injury to myself and the undersigned participants; and I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby hold harmless Jump On. In, their officers, agents, employees, other participants, and sponsoring agencies with respect to any and all injury, disability, death, or loss or damage to person or property to the fullest extent of the law; and by signing below for my children, and/or spouse, I also agree to the above conditions, should I decide to participate.
Participant(s): ______________________________________________Date of Birth ____/____/____ Name
Address/Street: _________________________________________City: _______________________ State: _____ Zip: __________
Parent/Guardian Signature: ____________________________________Date: __________________
Parent/Guardian Printed Name: ____________________________________________________________________________
Please print clearly Emergency Number if dropping off:
We occasionally take photos for our web site. Please check this box if you do NOT want your child’s picture used.
Please print your email address clearly to receive notices and special offers:
Email address: ________________________________________________________________________________
ESSEX AGRICULTURAL & TECHNICAL HIGH SCHOOL
562 MAPLE STREET PO BOX 362 HATHORNE, MA 01937
Student Program Information, Assumption of Risks and Agreements of Release and Indemnity
Essex County Sheriff’s Department
School Name Youth Leadership Academy Program Date(s)___________________
Dear Parent: WELCOME TO ESSEX AGGIE’S HIGH 5! Please read this document carefully. Parts I, II and Ill seek medical and other information about your child. Part IV contains important information about the High 5 experience and may affect your legal rights and those of your child in the event of an injury or some other loss. The document must be signed by at least one Parent.
Activities and Risks: High 5 programs are designed to be age appropriate and well within the capabilities of children in reasonably good health. They incorporate a variety of activities including games and problem solving initiatives. Each child may choose the level of his or her participation. Minimizing risks is a high priority at High 5, but participants and their families must understand that there are risks of physical or emotional injury, and must assume those risks. While the risk of injury is small, participants may suffer sprains, abrasions and other, more serious, physical and emotional trauma. Injuries and other losses can result from, among other causes, moderate to strenuous activity including the possibility of falling, abrupt contact with fixed and other objects and persons, close personal contact with other participants or staff members, including the possibility of inadvertent and unwelcome touching, and misjudgments of other participants. High 5 recommends that participants be covered by health and accident insurance for the duration of their participation.
Managing risks effectively is very important in all of our programs at Essex Agricultural & Technical High School. Please help us by providing the information requested below. Let us know if your child has any condition (current or past) that could affect his/her involvement in all activities and provide any other information that will help us provide a productive and enjoyable experience.
If you have any questions about your child ‘s program, don’t hesitate to call the Essex Agricultural & Technical?High School’s High 5 office at 978-750-9210.
Part I – General Information?Student’sName —————-Date of Birth
Address ——————- Sex Male Female
Name of Parent/Guardian ————- Home Phone #
Address —————— WorkPhone_________________
A Public Regional Vocational Agricultural High School · Commonwealth of Massachusetts
Danvers Fire Department?64 High Street Danvers, Massachusetts 01923 978-762-0245 Fax 978-762-0246
Imagine you are a young child and you awaken one night to find your bedroom filling with smoke. Your house is on fire! What would you do?
To make sure your child has the skills that can potentially save his/her life, we will be teaching burn prevention and fire safety in class. A key element of this learning process will include a tour at school of the Fire Safety House.
This mobile classroom is specially designed to teach children vital burn prevention ad fire escape techniques through a fun, safe simulation of common hazards. The fire Safety House is equipped with a kitchen, bedroom, and living room.
The House fills with a nontoxic water based smoke. This realistic environment teaches children to ‘crawl low’ to safety. A heated door helps children choose the right exit. An escape ladder is used to exit from the bedroom.
If your child suffers from asthma, other respiratory conditions or allergies that may be irritated by the nontoxic smoke, please indicate that below before allowing him/her to tour the House.
Note: All participants should wear pants/shorts and no-heeled shoes the day of the tour.
Check one Child’s Name?____My child______________________________may tour the Fire Safety House.
____My child______________________________may not tour the Fire Safety House.
____My child, has asthma, an allergy or respiratory condition that may be irritated by the nontoxic smoke and should not be in the House during that part of the program.
________________________________ ______________________ Parent/Guardian Signature Date
Rock Wall Release and Assumption of Risk Form (Required for Group Participants)
Since La Vida’s beginning in 1970, it has had an excellent safety record. All activities are well within safety limits and standard procedures are strictly enforced by trained instructors. The La Vida policy, “Challenge by Choice”, means that each participant determines the level and extent of their participation. The staff will encourage participants to try each activity, but will not use or allow peer pressure to force any participant to do anything they would prefer not to do.
But we are required by law to inform each participant of the risk and danger involved in adventure activities. Therefore, this “Release and Assumption of Risk” form has been drawn up and must be signed by each participant and the parents of minors.
I am aware that during La Vida’s Rock Wall certain risks and dangers may occur which are out of the control of the instructors. I further realize that I will be participating in activities in which the risk of an accident may be greater than in my normal way of life.
Although I know that safety procedures and precautions are in place, I know that I will be climbing vertical walls as high as 28 feet and that falls may occur possibly causing scrapes or other injuries.
In consideration of the right to participate in such activities, I have and do hereby assume all the above risks, and will hold Gordon College, and the Rock Wall Instructors harmless from all liability, actions, causes of actions, debts, claims, and demands of every kind and nature which might arise in conjunction with my participation in La Vida’s Rock Wall.
I also acknowledge the fact that the instructors have the right to terminate my participation in the Rock Wall because of my health or physical condition. I agree that the decision of the instructors shall be binding upon me.
Name of Participant
Signature of Parent or?Legal Guardian Date
Photo Release – I give La Vida and Gordon College permission to use any and all photos taken of me, during the Rock Wall and other La Vida activities for promotional materials.
Name of Participant?Signature of Parent or Legal Guardian
Rock Wall Medical History and Emergency Form
ST: Zip: Sex:
Address:?Phone: (?Person to be notified in case of injury: Home Phone: ( )
Date of Birth:
Work Phone: ( )
1. Confidential Fitness Readiness Questionnaire MUST BE FILLED OUT?Many health benefits are associated with regular moderate exercise, and we’ re glad you have chosen to increase
your level of physical activity. For most people an increase in physical activity should not pose any problem or hazard. However, for a small number of adults an increase in physical activity, particularly rigorous physical activity, might be inappropriate. There are also those who should have medical advice in choosing a type and level of activity right for them. The following checklist can help guide you in how to proceed with your new choice, and will guide us in helping you reach the level of activity right for you. Please check the following as they apply to you—
? Yes ? No• Have you exercised regularly within the last 3 months??? Yes• ? No Are you age 65 or older and not accustomed to vigorous exercise?
Please check the following Heart/lungs?? chest pains• ?shortnessofbreath•
? cancer•?? coronary disease•?? arthritis?? Other:?If you checked any items marked (•) above, please briefly explain:
symptoms or history which apply to you— Vascular Bones & joints?? leg cramps ? stiffness ?varicoseveins ?swelling
? seizures• ?tremors?? fainting/blackouts• ? dizziness/vertigo?? localized numbness
? poor healing
? pain/tenderness?? pain upon movement• ? limited movement
? diabetes ? stroke•
? high blood pressure• ? high cholesterol
Readiness Questionnaire Part II: Physician’s Statement and Clearance Waiver
If you did not check off any of the items marked (•) in Part I, please sign the following statement:
I have not answered yes to any of the items marked (•). I certify I am in good health and have never been advised not to participate in strenuous exercise and have never been diagnosed with any health or physical condition such as heart condition, hypertension or other condition which would render my use of the Bennett Center’s fitness center and other programs dangerous to my health.
If you checked off any of the items marked (•), you are required to have a Physician’s Statement and Clearance (PSC) form completed by your primary care physician prior to beginning activity in the climbing wall. Forms are available at the Control Desk. Please attach it to this form or bring it to the Control Desk at the Bennett Center. If you have not already provided us with a PSC form within the last 30 days, you must provide this form before beginning activity in the climbing wall OR you may sign the following statement:
Although I have answered YES to one or more of the items marked (•) in the Readiness Questionnaire, I have decided to forgo the Bennett Center’ s requirement to be provided with a Physician’ s Statement and Clearance (PSC) form from my primary care physician and I am aware of the risks associated with my activity. Parent’s/Legal Guardian’s Signature_____________________________Date__________
Please fill out this sheet and send with application.
My child did not attend 2014 Youth Academy_________?Youth Leadership Academy Parent Survey for 2014
If your child attended the 2014 Youth Academy please assist us in solidifying funding for next year’s academy by filling out this short questionnaire. Please rate each question with a score of 1 through 5.
1 – No affect, 2 – Minor affect, 3 – Neutral, 4 – Moderate affect, 5 – Major affect
1. Did this program improve your child’s knowledge of the dangers of drug use? 12345 ?
2. Did the Youth Academy improve your child’s knowledge of the dangers of alcohol use? ?12345 ?
3. Did the Youth Academy improve your child’s knowledge of the dangers of cyberbullying? ?12345 ?
4. Did the Youth Academy improve your child’s personal ability to work in a team building environment? ?12345 ?
5. Do you feel your child had an overall positive experience at the Youth Academy? 12345 ?
Thank you again for all your support. Please email or call me if you have any questions or concerns. Happy Easter,
Weekly Parent Update 3/28/15
I hope this email finds you and your families well on this Saturday morning. Week 2 of PARCC testing has gone smoothly thanks to Dr. Thakkar and the teachers’ hard work and collaboration. The volleyball season is off to a great start. Our student/athletes have been practicing and competing hard to bring two more championships home to Consentino. Below are some important events/reminders:
• March 30- Elementary teachers will not be available after school due to curriculum meetings.
• March 30- Academic Bowl Tournament @HHS- Seniors 6:45, Juniors at 4:30. Good luck to the Chargers.
• April 1- Report cards issued for Trimester 2 for K-8 students.
• April 2- K-8 parent/teacher conferences from 6:00-7:30 pm. Conferences are usually 5-10 minutes long. If you wish to speak to your child’s teacher further, please schedule an appointment via my office staff.
• March 31- Volleyball vs. Sacred Heart @ Consentino
• April 1- Volleyball @ Hunking
• K-4 Parents-Beginning Monday morning, we ask that your child enter the building in the back of the school where the playscape is located between 8:05 and 8:25. Children will no longer be allowed to enter the building through the canopy doors. The kiddos will still proceed to the gym due to the significant amount of snow in the back of the school.
• Parent pick up time is 2:30 for elementary and 2:45 for middle school. Remember to take a right turn out of the parking lot. This will help to minimize the traffic at dismissal.
• The March-June school calendar has been revised by the School Committee. Please check out our website at www.haverhill-ps.org/consentino. Dr. Thakkar has a link to the updated calendar.
• April 3- No school- Good Friday.
• Our office hours are 8:00-3:45.
If you ever have any questions or concerns, please call the office or email me at email@example.com. I check my email immediately and I will get back to you ASAP. Enjoy the weekend with your families.
Weekly Patent Update 3/21/15
I hope you are enjoying this weekend with your families. Spring is finally here but it is still snowing! Let’s hope the temperatures begin to warm up. This has been a very busy week at Consentino. The PARCC computer-based testing began on Monday. This has gone smoothly thanks to Dr. Thakkar and our unbelievable staff. If you have any questions about when your child is testing, please contact Dr. Thakkar, Mr. Oelerich, or I via email or phone. We will get back to you ASAP.
Below are some important events/reminders:
• Marks closed yesterday for the second trimester. Report cards will be distributed on April 1st. Parent/teacher conferences will be held April 2nd from 6:00-7:30 pm. The updated calendar is available on our website www.haverhill-ps.org/consentino
• April 3- Good Friday- No school.
• March 24- Volleyball @ Consentino vs. Nettle
• March 26- Volleyball @ St. Joseph’s
• K-4 parents: Please drop off your children on the canopy side. There is still a significant amount of snow in the back, and we are having the kiddos stay in the gym before school until the snow melts. I will update you as to when we change this routine.
• We try to go outside for recess everyday if the elements allow us to. This has been a brutal winter and we need to get out for fresh air. Children must come to school dressed for the weather conditions.
• Please do not drop your child off before 8:05. There are no staff members on duty until this time.
• If you change your address or phone number, please contact my office staff at 978-374-5775.
• From Mrs. Prochilo:
• 8th Grade Students/Parents:
• Applications for the new Haverhill High School STEM Academy Information Technology Pathway are now available in Guidance with Mrs. Prochilo. The application deadline is Monday, April 6 at 3pm. This National Academy Foundation IT Pathway Class of 2019 is limited to 24 freshmen, so don’t delay! Please note that only the IT Pathway requires an application at this point. Other STEM Pathways may be declared during a student’s freshman year. Visit hhs.haverhill-ps.org/stem-academy for more about the IT Pathway and other STEM Pathway options. Learn more about the National Academy Foundation at www.NAF.org.
From Mr. Roberts at HHS:
Hey, eighth graders! Are you thinking about joining a technology-related club at the high school? Ham Radio is a popular hobby and service in which licensed radio operators operate communications equipment. They provide communications at times of emergency and during events like marathons and parades. It’s a great hobby for anyone interested in electronics or talking to other hams around the world. Students interested in becoming a ham radio operator can take a one-day class in early April to prep for the licensing exam. Get licensed now and be ready to have some fun in the fall! Contact Mr. Roberts firstname.lastname@example.org for more information about ham radio or our other STEM-related clubs.
Dean of STEM / Science & Technology
Thank you again for all your support. I am privileged to have the best parents, students, and staff in the city. If you ever have any questions or concerns please email me at email@example.com.
Weekly Parent Update 3/14/15
I hope this email finds you and your families well on this Saturday morning. The teachers and students are ready for the PARCC test on Monday. Dr. Thakkar has been working tirelessly to make sure the computer-based exam goes well. If you have any questions about the PARCC, please call Dr. Thakkar, Mr. Oelerich, or I.
Below are some important reminders/events:
• March 20- Marks close for second trimester.
• March 16- PARCC testing begins. If you have any questions, please call or email one of us.
• Drop off time is 8:05. Please pull all the way down the driveway. Mr. Oelerich and I are outside every morning to help facilitate this process.
• We are continuing to allow the K-4 students to enter the building through the canopy side due to the amount of snow in back of the building. Dr. Thakkar is out there every morning if you have any concerns or questions.
• In the morning, parents are not allowed to walk in the school without checking in at the office. This procedure is in place for the safety of your child.
• Volleyball season is in full swing. Games begin on March 24th. I will send out the schedule next week.
• From Mrs. Prochilo:
• 8th Grade Students/Parents:
• On Monday, March 16, applications for the new Haverhill High School STEM Academy Information Technology Pathway will be available in Guidance with Mrs. Prochilo. The application deadline is Monday, April 6 at 3pm. This National Academy Foundation IT Pathway Class of 2019 is limited to 24 freshmen, so don’t delay! Please note that only the IT Pathway requires an application at this point. Other STEM Pathways may be declared during a student’s freshman year. Visit hhs.haverhill-ps.org/stem-academy for more about the IT Pathway and other STEM Pathway options. Learn more about the National Academy Foundation at www.NAF.org.
Thank you again for all your support. If you ever have any questions or concerns, please email me at firstname.lastname@example.org or call the office. Our office hours are 8:00-3:45. Enjoy the weekend with your families.
Weekly Parent Update 3/7/15
I hope this email finds you and your families well on this Saturday morning. It appears that spring weather may be finally coming next week according to the reports. Thank goodness.
Our PARCC testing schedule is finalized. If you have any questions, please call or email Mr. Oelerich, Dr. Thakkar, or I and we will be happy to assist you. The PARCC testing window is March 16-April 17.
Below are some important events/reminders:
• Manchester Monarchs day today at 3:00. Our chorus and band members will be performing before the game. Thank you again to Miss Cranton for all her efforts.
• Parent kindergarten information night and pre-registration workshopWHEN:March 11, 2015 @ 6:00 pm – 7:30 pmWHERE:Haverhill High School
137 Monument Street
Haverhill, MA 01832
• March 12- PTO 1:00 pm in Room 8.
• Middle school staff will not be available after school on Monday due to their curriculum meetings.
• Volleyball season is fast approaching. Good luck to the Chargers. We look forward to winning the boys and girls championships.
• Drop off time is 8:05 am. Please do not drop off your child before that time since there are no staff members on duty.
• Remember to take a right out of our parking lot when dropping off/picking up your children.
• In the morning, please pull all the way down the lot. This will help to alleviate the traffic on Washington St.
• We try to go outside for recess every day. Be sure your child has the appropriate clothing for outdoor recess.
Thank you again for all your support. I am truly blessed to have the best families and staff in the city. If you ever have any concerns or questions, please call or email me at email@example.com. Enjoy the day with your families.
Revised School Calendar
Weekly Parent Update 2/28/15
I hope this email finds you and your families well on this cold Saturday. We finally had a full week of school with no snow days! Let’s hope that Mother Nature will spare us in the coming weeks.
The kiddos and teachers have been working hard to prepare for the upcoming PARCC tests. As you know, the students will be taking the computer-based exam. The testing window is March 16-April 17. Dr. Thakkar is in the final stages of preparing a schedule as to when each child will be testing. If you have any questions, please call me or Dr. Thakkar.
Below are some important events happening this week:
• March 3- Spring Pictures. Notices have gone home with the children.
• March 4- Early Release- Dismissal is at 11:05.
• Boys volleyball tryouts will be Tuesday and Thursday afternoon from 3-4pm.
• The district calendar has been recently revised by the School Committee. Please check out our website (www.haverhilll-ps.org/consentino). Dr. Thakkar will be posting the revised calendar for March-June today or tomorrow.
Below are some important reminders:
• Students are not allowed in the building before 8:05.
• When dropping off your child near the gym side, please pull all the way down the driveway. This will lessen the traffic on Washington St. and make for a smooth procedure.
• If you are picking up your child, please be patient. There is a lot of snow and we want to be sure our children are safe. We have staff situated in strategic areas to help facilitate this process.
• When exiting our lot in the morning and afternoon, you must take a right on Washington St.
• K-4 Parents: Until further notice- When you drop off your child in the morning on the canopy side of the school, have your child enter through the canopy doors of the building. Dr. Thakkar will be outside to assist in this process. There is a lot of snow in the back of the school, and we want the little ones to be safe when entering the building. Our K-4 students will then be directed to the gym by staff members.
• We will try to go outside for recess for fresh air if the elements allow us to. Please make sure your child wears jackets and gloves each day.
Thank you again for all your support. If you have any questions or concerns, please call or email me. I will get back to you ASAP. Enjoy the weekend with your families.