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Hersheypark Trip
Information
May 14-17, 2007
Katie Barry & Kristen Calohan, instructors
(845) 294-2502
Trip Description
The
trip is designed to provide students with a unique
performance opportunity. Each group will perform
for judges and be given a ranking. The comments of
each judge will be available for us to listen to and
learn from. In addition to performing and being
judged, students will get to spend time with their
musician friends in Hersheypark as a reward for all
their hard work!
Payment
Schedule
Total cost: $150/student
-
$25
due with commitment form (November 1)
-
$41.25due February 1
-
$41.25
due March 1
-
$42.50
due April 1
Transportation, lodging, park admission, and 2 meals
are included in the cost of the trip.
*Students will need
to bring a bagged lunch for Friday and have money
for 2 meals and souvenirs.
*Please make checks
payable to CJH Middle School
Fundraising
By fundraising,
the total cost can be reduced. Please let us know
if you have any ideas or if you are interested in
helping with a fundraiser.
Room Assignments
Students will stay
4 to a room at the hotel. Room assignments will be
done by student choice. In the event of behavior
problems, the directors will reassign students as
they see fi
Tentative Itinerary
Friday May 16:
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Depart CJH Middle School (AM)
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Eat bagged lunch on bus
-
Check into hotel
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Dinner
-
Prepare for performance
-
Performance (PM)
-
Return to hotel
Saturday May 17:
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Breakfast at hotel (provided)
-
Depart for park
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Lunch in park (provided)
-
Awards Ceremony
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Dinner in park
-
Depart for Goshen
-
Arrive in Goshen (late PM)
*A more detailed itinerary
will be available closer to the trip date.
Hersheypark Trip Commitment Contract
Due November 1
Student
Name______________________ Grade___________
Music Group(circle
one):
Wind Ensemble/Orchestra
Parent/Guardian
name(s)_______________________________________
Phone #_____________________________
Alternative phone #______________________________
**Please list 2 other
emergency contacts below in case parent/guardian
cannot be contacted.
Name______________________________ Phone
#___________________
Name______________________________ Phone
#___________________
I,
________________________, commit to participating in
the wind ensemble/orchestra trip to Hersheypark on
May 11-12, 2007. I understand that in order to
attend the trip I must pay $150 by April 11, 2007.
Student
Signature________________________ Date____________
Parent/Guardian
Signature______________________ Date__________
Goshen
Central School Medical Form
Music
Department Hershey Park Trip
(to
be completed by the Parent/Guardian and Returned by
11/1/06 Mrs. Barry or Mrs. Calohan)
Student Name_____________________________
Birth
Date________________
Parent/Guardian___________________________
Home Address_____________________________
Phone Number(Home)______________________ Phone
number(work)_______________________
Family Doctor_____________________________ Phone
Number__________________________
Ins. Carrier________________________________ Policy
#_________________________________
----------------In
an emergency, if unable to reach parent, contact--------------------
Name_______________________________
relationship_________________ Phone_________________
Name_______________________________relationship__________________Phone_________________
-------------------Does
Your child have any problems with the
following?--------------
Yes
No
Yes
No
Yes No
___ ___ Asthma
____ ____ Allergies
____ ____ Insect sting Allergies
___ ___ Seizures
____ ____ Hearing Loss
____ ____ Sleep Walking
___ ___ Diabetes
____ ____ Heart Problem
____ ____ Strenuous Exercise
If Yes to any,
explain:_________________________________________________________________________________________________________________________________________
Does your child have any serious medical problems or
been under a physicians care recently? Yes_______
No_____ If yes
explain:________________________
Does your child have food
allergies:__________________________
Allergies to
medications:_______________________________
Diet
restrictions:______________________________________
Has your child received all the required
immunizations? Yes______ No______
What date was the last tetanus Shot?_______________
------------------Medications---------------------
The students may not have any medications (pill or
oral liquid) in his/her possession. This includes
over the counter medication like Tylenol. All
medication must be give to and be held by a school
representative, who will administer it according to
the written instructions. All medication must be in
the original pharmacy container and delivered by
Thursday May 10, 2007 by the parent/guardian to Mrs.
Barry or Mrs. Calohan.
My child may have the following medication if needed
(please check)
____Tylenol ____cough Medicine
____Antacid ____Other___________
These should be in original container and labeled
with child’s name. List any prescription medications
your child must take on a regular schedule.
Medication
Dosage How
Often When
________________________________________________________________________________________________________________________________________________
To the best of my knowledge the above information
give is correct and my child has permission to
engage in all activities. In case of medical
emergency, I understand I will be notified as soon
as possible by the school representative. I hereby
give permission to the physician selected by the
Director of his designee to hospitalize, secure
treatment for and to order injections, anesethia or
surgery for my child as named above. I also give
permission for my child’s school representative or
staff to transport my child to the hospital or
medical/dental office if needed. Any directions to
the contrary should be specified at the bottom or
the back of this form and signed.
Parent/Guardian
Signature__________________________
Date________________
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