COUNCIL ROCK SCHOOL DISTRICT NEWTOWN MIDDLE SCHOOL

PARENT PERMISSION FOR OPTIONAL OR SUPPLEMENTAL ACTIVITY

TO: Parents/Guardian of ______(keep top half for your records)

FROM: Synergy RE: team trip PRINCIPAL: Mr. Tim Long

Your permission is requested for your child to participate in the extended study activity described below. This is a supplemental and optional educational activity which, in the school’s opinion, has educational value. Non-participation, however, will have no effect upon the student’s completion of course requirements.

Name and Description of Activity: McCarter Theater

Purpose: The 7th grade students will see: MURDER ON THE ORIENT EXPRESS (themes in Literature & Drama) The exotic Orient Express is about to go off the rails! With a locomotive full of suspects and an alibi for each one, it’s the perfect mystery for infamous detective Hercule Poirot, n’est-ce pas? Wax your mustache and hold onto your passport— Adapted from Agatha Christie’s masterpiece, Tony Award-winning playwright Ken Ludwig and multi-award-winning director Emily Mann will take you on a suspenseful, thrilling ride aboard the legendary Orient Express

Transportation arrangements: School buses

Provision for meals: Bag lunch-please plan to pack a lunch.

Costs: _$25.00______CASH ONLY.

Date: March 30th. Buses will leave at PROMPTLY AT 9:00 am and return by 2:30 pm.

*DRESS APPROPRIATLEY=THEATER ATTIRE (no t-shirts, sweat pants-suggested dress: Boys =Khakis/dress shirt/oxford, Girls = dress/trousers/oxford/dress shirt) NO CELL PHONES

------Cut along dotted line and return stapled to Medical form ------

PARENT/GUARDIAN: Please complete the bottom of this form and page 2 form and return it to your child’s homeroom teacher by 11/1/2016 to be eligible to participate.

I hereby grant permission for ______to participate in the 7th grade team Synergy Field Trip.

______Parent/Guardian

(Please staple this to page 2-the extended student activity permission/medical authorization form) COUNCIL ROCK SCHOOL DISTRICT EXTENDED STUDENT ACTIVITY PERMISSION/ MEDICAL AUTHORIZATION

Student Name ______Grade/Homeroom ______

Planned Activity: McCarter Theater Date of Activity: March 30th 2017 Dear Parent or Guardian:

In anticipation of your child’s upcoming extended student activity, please supply the following information. In compliance with the District drug and alcohol policy and medication policy, no student is permitted to carry any form of medication. Arrangements for transport of medications essential to health (insulin, inhalers, anti-seizure medications, epi-pens should be made with the school nurse. If your child will need any medication during the extended activity, you are encouraged to accompany your child.

PARENT OR GUARDIAN OF STUDENTS REQUIRING DAILY MEDICATION MUST CHECK ONE OF THE FOLLOWING:

______I understand that my child will omit his/her daily scheduled medication on the day of the extended activity.

______My child may take his/her regularly scheduled medication upon returning to school.

______I will accompany my child on the extended activity and will administer her/her medication.

If you have any questions about medication administration during extended student activities, please contact the school nurse.

THE FOLLOWING INFORMATION MUST BE SUPPLED FOR ALL STUDENTS ATTENDING THIS EXTENDED ACTIVITY:

A PARENT OR GUARDIAN CAN BE REACHED AT THE FOLLOWING TELEPHONE NUMBERS ON THE DAY OF THE ACTIVITY:

Home Phone ______Work Phone – Mother ______Work Phone - Father ______

PERSON TO CALL IF A PARENT OR GUARDIAN CAN NOT BE REACHED

Name ______Telephone Number ______

PHYSICIAN: Name ______Telephone Number ______

ANY SERIOUS ALLERGIES OR MEDICAL CONCERNS: ______

I give my child permission to attend the above mentioned activity and in case of illness or emergency, I authorize the officials of Council Rock School District to contact directly the persons named on this form. In the event parents, physician, or other persons named on this form cannot be contacted, the school officials are authorized to take whatever action is deemed necessary for the health of my child. Please complete the following and return to RMS. Thank You! SCHOOL COPY ______Date Signature of Parent or Guardian