19 - ncps-k12.org

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Sponsored by New Canaan Public Schools Directors: Darren Bruce and Brett Gillan

www.ncps-k12.org/domain/748 [email protected]

New Canaan

Summer Enrichment

2019

Open to Non-Residents

A Total Summer Experience

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June 24, 2019 through July 19, 2019

Once again we are offering a range of activities for a total summer experience! We encourage online or mail-in registration by May 31, 2019 as class sizes are limited and filled on a first come, first served basis. Courses without sufficient enrollment will be cancelled.

Open course registration, if space is available, will take place at East School beginning June 20th.

Register online at: www.ncps-k12.org/domain/748

Mail in registration forms can be found in the back of this booklet or on our website, www.ncps-k12.org/domain/748.

Refund Policy

In the event a course is canceled due to insufficient enrollment,

students will be refunded the entire registration fee.

NO refunds will be made for any course unless the course is canceled Please understand that we hire staff

and order materials based on projected enrollment well in advance of the start date of a course.

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Language Arts Camps

#010 The “Start Now” College Essay Workshop

Completing grade 11 4:00 - 7:00 New Canaan High School $225 (Note: This is a four day camp and will run from 6/24-6/27) Juniors, can we talk? Summer is around the corner and generations of college-

bound students have had the exact same question that is taking shape in your

mind now: How the heck do I arrange 500 words into an essay that will soften the

steely hearts of faceless college admissions personnel and move them to let me

pass through the magic portal into the promised land of higher education?

Easy! You can spend four days developing an essay in a supportive workshop envi-

ronment and approach application deadlines with the confidence that you’ve al-

ready written a solid personal statement.

Instructor: Darren Bruce (NCPS Writing Specialist)

June 24th—June 28th

Register online! Visit or website at www.ncps-k12.org/domain/748. Look for the link on the left hand side!

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Language Arts Camps

#100 Keyboarding

Completing grades 1 - 6 8:00 - 9:00 East School $85

In this technological world, keyboarding skills are essential! This one hour camp will

give you a boost to your technology skills, including keyboarding. Learn proper hand

placement on the keyboard with a focus on the home row. You will play games and

activities that promote your keyboarding speed and accuracy in a fun way.

Instructor: April Colon (South)


#101 Lights, Camera, Action

Completing grades 2 - 4 9:00 - 12:00 East School $250 (Note: on Wednesday 6/26 camp will be at New Canaan High School)

Have you ever wondered how your favorite movies get made? Have you ever dreamed

of making your own movie? In this week-long camp, you will learn what goes on be-

hind the scenes and what it takes to make the movies you see in the theaters today.

You will write a script for a scene, learn how to direct actors, film the scene, and edit it

using iMovie software on an iPad. You will even learn about some of the amazing spe-

cial effects at New Canaan High School’s film studios. By the time you are done, you

will know exactly what it means when someone yells, “Lights! Camera! Action!”

Instructors: Stefanie Sommerville (West), Maureen Correa (West)

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#102 Simply Superheroes

Completing grades K-2 9:00 - 12:00 East School $250

Are you faster than a speeding bullet? Can you leap tall buildings in a single bound? Is

there a superpower lurking in you that’s just waiting to come out? In this weeklong

camp, you will explore your inner superhero, designing your own cape and mask,

writing your own superhero story, and testing your powers on a superhero obstacle

course. When you’re done, you will be ready to team up with Batman, Superman, and

Wonder Woman to make the world a better, safer place.

Instructors: Tania O’Leary , Kerry Zrenda (West)

#104 Pirate Camp

Completing grades Pre-K-1 9:00 - 12:00 East School $250

Shiver me timbers! A band of jolly pirates has dropped anchor and

wants you to join them for a week of fun. This is your chance to find out what life was

like for a pirate on the high seas. Each day you’ll learn something new about the pirate

experience - learn to speak and dress like a pirate, follow maps to buried treasure, read

about famous pirates of long ago, create your own flag and more! Captain Fritz will help

transform you from lowly land-lubber to a veteran seadog. Yo ho, yo ho, it’s a pirate’s

life for thee!

Instructor: Ryan Fritz (East)

#103 Top Chef: Made in the USA!

Completing grades 3-6 9:15—12:15 New Canaan High School $275

Open up and say yummmm! In this weeklong camp, you will learn the sweet science be-

hind some of this country’s most famous food! Working in New Canaan High School’s

classroom kitchens, otherwise known as the Rams Café, Chef Barbosa will help you whip

up some tasty treats like Chicago’s deep dish pizza, Florida’s key lime pie, or New Eng-

land’s famous apple crisp. By the end of the week, you will be able to go home and turn

your own kitchen into a world-famous eatery!

Instructors: Laura Barbosa (South), Meghan Finn (East)

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#107 Project Lead the Way: Robotics

Completing grades 4-7 9:15 - 12:15 New Canaan High School $250

Welcome to the wonderful world of robotics! In this weeklong camp, you will learn

how to design and build your own mobile robot, capable of following your every com-

mand via remote control. Once your robot is built, you will be able to program it to

carry out a number of tasks. This hands on experience in mechanical design is just a

start as to how some of the world’s most sophisticated robots operate.

#106 Lego Robotics

Completing grades 1 - 3 9:00—12:00 East School $250

Do you love LEGOS? At this camp, you will learn how to design, build, and program

working robots using LEGO WeDo Robotics ®. Create stories based on the characters

you develop as these hands-on activities promote innovation, problem-solving, and

collaboration as well as computer and literacy skills.

Instructors: Scott Dempsey (Wilton Public Schools), Christina Fulco (Saxe)



#105 Future Babysitters Club


Babysitting? How hard could it be? In this week long camp, you’ll find out just how chal-

lenging it can be to take care of kids while their parents are out. Our instructor will guide

you through the babysitting basics, where you will learn how to take care of infants and

children, how to stay safe and what to do in an emergency. You will also get hands on

experience feeding, burping, and changing diapers using our infant simulators. Pretty soon

you’ll be ready to start your own babysitting business!

Instructor: Donna Sapienza (NCHS, Family Services Teacher)

STEM Camps

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Arts Academy Camps


#109 The Art of Kindness

Completing grades K-2 9:00—12:00 East School $275 In this weeklong camp, kids will explore literature, learn songs, play games, and, most importantly, create a number of different art projects all focused around the ideas of friendship, sharing, caring, and kindness. Turn a pile of beads into a beautiful friendship bracelet. Use modeling clay to create little works of art that warm the heart. Paint rocks and plant construction paper flowers to make your own “Kindness Garden.” Who knew kindness and caring could look this good!

Instructor: Michelle Young-Hutchinson, Jennifer Derby

#110 Discovery Arts

Completing grades K-2 9:15—12:15 New Canaan High School $275

Science isn’t just all formulas and equations—there is an art to it, too. This workshop com-

bines the best of art and the best of science as you create some amazing artwork. Make

your own science inspired art creations. With a little bit of experimentation and a lot of

creativity, you’ll be surprised at how beautiful science can be!

Instructor: Eleanne DeLeo (Stamford Public Schools)

#108 Glam Squad

Completing grades K-2 9:15—12:15 New Canaan High School $275 Any fashion-forward person knows that the key to great fashion is the accessories. Create

your very own unique fashion statement and become a trendsetter. Style and customize

your own jewelry, headbands, hair ties, belts, and clothing just the way you want them.

You name it, we can make it!

Instructor: Karla Duran (Stamford Public Schools)

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#111 Junior Arts Studio Completing grades K-2 9:15—12:15 New Canaan High School $275 Explore diverse media in a playful atmosphere. The teacher’s demonstration will act as a

springboard to explore, experiment, and create authentic art pieces each day. Closing

each session with a reflection circle, students will have the opportunity to offer positive

observations about classmates’ work and reflect on their own discoveries.

Instructor: Megan Collins (Silvermine), Jen Berry (Saxe)

Register online! Visit or website at www.ncps-k12.org/domain/748. Look

#112 Hands On Art Completing grades 3-6 9:15—12:15 New Canaan High School $275

If you like to get your hands dirty then this is the art studio for you! Have fun creating hand built pottery, clay sculpture, paper mache creations, painting, and more. Most of these projects will be done in steps and will need time to dry in the sun or be fired in the kiln so campers may need to pick up their work at a later date. Don't forget to wear a smock! Instructor: Abigail Duncan (Saxe)

#113 Photoshop Magic

Completing grades 3-6 9:15—12:15 New Canaan High School $275 Learn to fool the eye and create astonishing illusions in Photoshop. Students will

shoot their own photos, and bring their images into Photoshop where they will

create pictures that will amaze their friends and fool their parents! You will learn

the basics of Adobe Photoshop in the process. Students can bring their own cam-

era or one will be provided.

Instructor: Duffy Franco (Norwalk Public Schools)

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#201 Summer Institute of Writing

Completing grades 1 - 6 9:00—2:00 East School $275

Come live the writerly life! Here’s the chance for those who love to write to unleash

their creativity in a nurturing community of writers. Each morning begins with

unique activities to stimulate the senses and inspire the writer within. Daily mini-

workshops are offered for specific ages for personal writing explorations. Afternoon

workshops allow time for writing and opportunities for conferring, revising, and

publishing. If you love to write, all you need to bring is your imagination. (This is

not a remedial writing program.)

Instructors: Darren Bruce (NCPS Writing Specialist), April Colon, Cori Horelik

(South), Kerry Needle, Janet McMullen (East), Tania O’Leary, Stefanie Sommerville,

Joanna Tamburro, Kerry Zrenda (West), Terri-Ann Adrian, Joanna Dobransky, Gina

Helmich (Saxe), Monica Sheehan (NCHS), Scott Dempsey (Wilton Public Schools)

#200 Keyboarding Completing grades 1 - 6 8:00 - 9:00 East School $75




activities that promote accuracy and keyboarding speed in a fun way.

Instructors: April Colon (South), Monica Sheehan (Saxe)

July 1st—July 5th (4 days)

Language Arts Camps

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Arts Academy Camps

#203 Hands On Art Completing grades 3-6 9:15—12:15 New Canaan High School $220

If you like to get your hands dirty then this is the art studio for you! Have fun creating hand built pottery, clay sculpture, paper mache creations, painting, and more. Most of these projects will be done in steps and will need time to dry in the sun or be fired in the kiln so campers may need to pick up their work at a lat-er date. Don't forget to wear a smock!

Instructor: Abigail Duncan (Saxe)


#202 Top Chef: Just Desserts

Completing grades 3-6 9:15—12:15 New Canaan High School $220 In this weeklong camp, you will learn the sweet science of baking in New Canaan High

School’s classroom kitchens, including the Rams Cafe. Chef Barbosa will help you whip up

some tasty treats like gourmet cupcakes, scrumptious cookies, and pastries that will make

your mouth water. By the end of the week, you will be able to go home and turn your

own kitchen into a world-famous bakery!

Instructor: Laura Barbosa (South)

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#204 Puppetry

Completing grades 2-4 9:15—12:15 New Canaan High School $220 Create your own furry monster with design techniques and materials used by professional

puppet builders. Did you know that eye and nose placement can change what we think

about how the puppet might act? Learn how to design bold, exciting characters and bring

them to life with specific puppet performance techniques like breath and focus as well as

general theater skills such as voice acting and ensemble performance.

Instructor: Christine Dempsey

#205 Discovery Arts






Instructor: Jen Berry (Saxe), Megan Collins (Silvermine)

#206 Craft Club

Completing grades K-2 9:15—12:15 New Canaan High School $220 Let’s get crafty! In this weeklong camp, you will get to use your creative side and spend the time making a number of colorful and festive crafts. Sand art and wind chimes are just a few of the crafts you will bring home each day. You’d be amazed what a little imagination and a lot of summer fun can create!

Instructor: Eleanne DeLeo (Stamford Public Schools)

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#207 Flip Books

Completing grades 3-6 9:15—12:15 New Canaan High School $220 Flip books truly were the first “moving pictures”! In this weeklong camp, you will write, design, create, and display your very own flip book movie. Learn how artists made movies before the days of video cameras and computer animation. During the week, you will craft a series of still images and combine them to make a mini-movie once the pages are turned. By the end of the week, you will be able to show your work over and over again in a handmade flip book projector. These little gadgets really are magic!

Instructor: Duffy Franco (Norwalk Public Schools)

#208 Drama Club

Completing grades K-2 9:15—12:15 New Canaan High School $220 Do you have a seriously creative side? This week-long camp will focus on bringing charac-

ters to life through playacting, characterization, and imaginative play. Campers will learn

to expand their imaginations, build their confidence and communication skills, and interact

in a group with other children their age. Campers will also add art, music, and creative

movement to their acting repertoire.

Instructor: Carolyn Smalley (South)

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July 8th—July 12th

Language Arts Camps

#300 Keyboarding Completing grades 1 - 6 8:00 - 9:00 East School $85

In this technological world, keyboarding skills are essential! This one hour

camp will give you a boost to your technology skills, including keyboarding.

Learn proper hand placement on the keyboard with a focus on the home

row. You will play games and activities that promote accuracy and key-

boarding speed in a fun way.


#301 In the Land of Fairies

Completing grades K-2 9:00 - 12:00 East School $250

Enter the fantastic, fascinating and magical world of fairies! Examine all kinds of fairy literature to find out where fairies live, what they like to do, what they wear and the food they like to eat. We will spend time outside creating fairy houses and fairy gardens. Read, write, draw and play games that the fairies love to play. If you have a wonderful imagination, then this class is for you!

Instructors: Stefanie Sommerville, Tania O’Leary (West)


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STEM Camps

#303 STEM Stories

Completing grades prek-1 9:00 - 12:00 East School $250

Don’t lose STEAM (science, technology, engineering, art, and math) this sum-mer! Combine your love of reading and your passion for science into one fun-filled camp experience. We will explore a number of scientific challenges and engineering concepts through a variety of well known and entertaining story-books. Ever think you could design a way to stop the Big Bad Wolf from blow-ing your house down? Or how about being inspired to craft a “walking rain-bow” after reading The Very Hungry Caterpillar. You’ll be amazed how much science there is in stories?

Instructors: Lisa Charkales, Carli Cross (South)

#302 The All-New American Girls


This ever-popular camp is back with new and exciting ways of exploring American History

through the characters of the American Girl books and dolls. We’ll focus on dolls from all

eras, including the present, as we play games and cook recipes, make crafts, enjoy music

and have a ton of fun. As you discover how these brave, creative, adventurous and caring

girls lived, you’ll reflect on your own talents, hopes and dreams. So bring your friends

(and dolls, of course) as we celebrate being American girls!

Instructors: Mary Hanna (Social Studies Coordinator) and Dana Tonelli (East School)

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#304 Camp Invention: Supercharged!


Camp Invention takes summer fun and transforms it from ordinary to extraor-dinary! In partnership with the National Inventors Hall of Fame, we are pleased to offer the nationally acclaimed Camp Invention program to children finishing first grade through third. It’s an exciting, weeklong summer adven-ture with lessons that explore connections between science, technology, engi-neering and innovation. Children will work together to seek solutions to real-world problems and sharpen critical 21st century learning skills while rotating through several fascinating modules. Here is how young innovators will be spending their time:

Creative Problem Solving: Children team up to rebuild ships and design under-water equipment in Deep Sea Mystery™.

STEM Application: In DIY Orbot™, participants explore circuit boards, motors and gears as they design a remote-control bot to take on obstacles from sports to dance. All activities give participants the opportunity to explore, discover and achieve while having fun!

Innovation: Children collaborate with inventor superheroes and take on roles of engineers, fabricators and innovators to conquer villains in Innovation Force™.

Confidence: Kids become successful entrepreneurs in Farm Tech™, as they code bots to turn a polluted wasteland into a money-making machine and create devic-es to save animals

Instructors: Michelle Buyer, Cori Horelik, April Colon (South), Patrick Murren (West),

Scott Dempsey (Wilton Public Schools)

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Arts Academy Camps

#305 Hands On Art


If you like to get your hands dirty then this is the art studio for you! Have fun creating hand built pottery, clay sculpture, paper mache creations, painting, and more. Most of these projects will be done in steps and will need time to dry in the sun or be fired in the kiln so campers may need to pick up their work at a lat-er date. Don't forget to wear a smock!

Instructor: Abigail Duncan (Saxe)


#306 Our Fur, Fin, and Feathered Friends


Do you love animals? In the weeklong camp, you have fun expressing the world

around you as you create mixed media masterpieces centered around animals of

all sorts. Whether it be a favorite pet, native wildlife, fish or birds, you will use a

variety of media including collage, markers, scratchboard, and mixed media to

create bird sculptures, pet rocks, animal masks, notecards, finger puppets, and

animal stories, among other fur, fin, and feathered friends!

Instructor: Kimanne Core (New Canaan High School)

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#307Junior Arts Studio Completing grades K-2 9:15—12:15 New Canaan High School $275 Explore diverse media in a playful atmosphere. The teacher’s demonstration will act as a

springboard to explore, experiment, and create authentic art pieces each day. Closing

each session with a reflection circle, students will have the opportunity to offer positive

observations about classmates’ work and reflect on their own discoveries.

Instructor: Jen Berry (Saxe)

#308 Actors Guild

Completing grades 3-5 9:15—12:15 New Canaan High School $275 Start your acting career with a series of activities that lay the foundation for eve-

rything to come. Not only will you be on your way to landing your first starring

role, but these acting exercises will help you build confidence in a number of so-

cial and academic situations. Activities will include acting in mini-snippets, scene-

starters, and small group improvisations. Whether you make it to Broadway or

not, being a part of the Actors Guild will make life a dramatic adventure!

. Instructor: Carolyn Smalley (South)

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Language Arts Camps

#401 Keyboarding





activities that promote your keyboarding speed and accuracy in a fun way.


#400 The World of Fancy Nancy

Completing grades Pre-K - 1 9:00 - 12:00 East School $250

Do you love being fancy? Join us for a week of glamour and glitz as we dive into

Fancy Nancy’s world. You will make elegant tiaras, sparkling jewelry, beautiful purses

and more. Dress in your fanciest outfits as we join Nancy and her friends for tea par-

ties. We just hope we have time for all the fun and fancy activities based on the Fancy

Nancy books!

Instructors: Tania O’Leary , Joanna Tamburro (West)

#402 On Your Mark...Get Set … Kindergarten!

Completing Pre-K 9:00 - 12:00 East School $250

Offered exclusively for children entering kindergarten in the fall of 2019, this camp will

ease the worry of the unknown and generate excitement for the year ahead. Campers

will experience typical routines in kindergarten, while learning valuable social, motor

and academic skills. We’ll also be reading books, singing songs and sharing poetry that

kindergarten teachers would love to know are part of a child’s “invisible backpack” as

they enter school in the fall.

Instructor: Karen Pedicano, Lisa Charkales (South)

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STEM Camps

#403 Hop on the Hogwarts Express


Join us for our 20th year of Hogwarts – as a first year or returning student! If you’re new,

the famous sorting hat will determine your house for the week! You’ll attend potions class,

write for the Daily Prophet, make your house t-shirt, play Quidditch, as well as engage in

creative dramatics. At the end of the week, the House Cup will be awarded.

The Wizards in Residence this term are Joanna Dobranksy and Elaine Scott (Saxe)

April Colon (South), Kerry Zrenda, and Stefanie Sommerville (West), Monica Sheehan (NCHS), Chris Dobransky (Facing History School), Scott Dempsey (Wilton)

#404 Rocketry


Up, up and Away! In this weeklong camp, you will learn what it takes to design, build

and launch rockets successfully into the stratosphere. Investigate the effects of weight,

aerodynamics, and different methods of propulsion on the speed and heights your rock-

et will soar. Learn the history of rocketry and about some of its most famous rocket

scientists. You will also try your hand at piloting a remote-controlled drone built with

Legos. The sky’s the limit at this exciting camp!

Instructor: Cori Horelik (South)

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Arts Academy Camps

#406 Interactive Book Arts


Get inspired by illustrators! From Leo Leonni to Eric Carle to Jan Brett, children of all ages

cherish the art of mentor illustrators. Picture book art can enhance, define, and compli-

ment a text, while the voice of the eye speaks to the viewer. Pop-up and flip books take

the idea of illustration to a whole new, interactive level. Experiment with various tech-

niques from mentor illustrators and then use simple folds and bookmaking techniques to

create keepsakes for your favorite writing to gift or to keep for yourself!

Instructor: Holly Martocci (Saxe)

#405 Logic Games and Lock Boxes


They say life’s a mystery, but it doesn’t have to be! In this week-long camp, you will ex-

plore the basic principles of logic and problem solving so that when you’re faced with one

of life’s little mysteries, you’ll be able to solve it with ease. Each day you will have to use

your logical thinking to open a series of unique locks and boxes. Using Breakout EDU’s

gaming platform, you will get hands-on and digital gaming experiences that promote col-

laboration, critical thinking, communication, and creativity. Who needs directions, when

you have the power of logic!

Instructor: Terri-Ann Adrian (Saxe)

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#407 Art in the Animal Kingdom


In this weeklong camp, you will make “animal art” using inventive techniques and

imaginative ideas. A range of media and ways of expressing your creative vision

will be taught. Scratch art, sculpture, paint, and drawing media will be used to

make pet portraits, design mascots, create sculptures —all kinds of art centered

around a favorite pet, native wildlife, fish or birds. You really will make amazing

art inspired by the whole animal kingdom.

Instructor: Kimanne Core (New Canaan High School)

#408 Discovery Arts






Instructor: Jen Berry (Saxe)

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Step One: Register with the Online Registration Form.

Scan the QR code to take you to our online registration form.You can reg-ister up to three children on each online form and for as many camps as those children would like to attend.

Step Two: Make a payment with School Cash Online.

Scan the QR code to take you directly to our payment portal, School Cash Online. If you already have a School Cash account, feel free to log in, search by camp #, add the camps to your cart, and proceed to check-out. However, you do not need a School Cash account to pay for our camps. If you do not have an account, simply click on the “Items” tab at the top right of the School Cash homepage, search by camp #, add the camps to your cart, and proceed to checkout.

Register Online!

You can now register for New Canaan Summer Enrichment camps online. By following these easy steps you are just a few clicks away from a fun-filled summer experience!

**If you are having trouble paying online: Scan the QR code to take you to our “Online Payment Pointers” that helps guide you through the steps. Thank you for your patience!

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For our campers’ safety, any child with a diagnosed,

life-threatening allergy to food or insect,

MUST have the physician’s emergency

medical protocol form completed and signed

by a physician and parent, according to state law,

BEFORE a child may attend a course.

Photos and videos may be used within a camp to showcase student learning.

Occasionally, these may also be used as publicity, but names will never be used.

Should you wish to opt out, please submit the request in writing.

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Summer Enrichment Registration

Child #1: Last _______________________ First ________________ Age ____

Completed Grade: ____ School: __________________________ M F


Completed Grade: ____ School: __________________________ M F


Completed Grade: ____ School: __________________________ M F Parent/Guardian’s Name: Last _____________________ First _______________

Street: _______________________________ City: _____________ Zip: _____

Home Phone: ___________________ Cell Phone: _______________________

Email: ____________________________________________________________

In case of emergency (if parent/guardian cannot be reached):

Contact: __________________________________ Phone: ______________

Contact: __________________________________ Phone: ______________

Indicate sensitivities or medical concerns to:

Bee stings ___ Nuts ___ Asthma ___ Diabetes ___ Allergies ____________

Other:__________________________________________________________

Any child with a diagnosed, life-threatening allergy to food or insect, MUST have the form on the reverse side completed and signed by a physician and parent, according to state law.

A nurse is not on the premises during camp. Consent is hereby given for my child to receive medical or surgical care as recommended by physician/hospital:

Parent/Guardian Signature: ________________________

Child Course # Course Name Week of: Amount

Register early to guarantee your space! Confirmations will be sent via email from [email protected].

Check your spam folder if you don’t receive it shortly after you register. Make checks payable to New Canaan Summer Enrichment.

Total:

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Physician’s Emergency Medical Protocol

Physician please complete the following:

Child’s Name: ________________________ Date of Birth:___________

Physician’s Name:_____________________ Telephone #:___________

Child’s Diagnosis:_____________________________________________

Specific Insect/Food Allergen:____________________________________

Has Asthma? Yes or No (Circle one)

If the child is stung, or has ingested or thinks he/she has ingested the above

named food:

PLEASE IDENTIFY BY NUMBER (1,2,3…) MEDICAL PROTOCOL

DESIRED

________Observe child for symptoms of anaphylaxis

________Administer Benadryl_____________________(state specific dose)

________Administer Epinephrine (Epi-pen,jr.) 0.15cc before symptoms occur.

________Administer Epinephrine (Epi-pen,jr.) 0.15cc if symptoms occur.

________Administer Epinephrine (Epi-pen) 0.30cc before symptoms occur.

________Administer Epinephrine (Epi-pen) 0.30 cc if symptoms occur.

Any child treated for anaphylaxis will be transported to the nearest

Emergency Room.

______________________________ ____________

Physician’s Signature Date

Parent/Guardian Authorization:

I hereby request that the above medication, ordered by the physician for

my child _______________________be administered by authorized school

personnel.

Signature______________________Relationship to child_______________

Phone#_____________

27 28

PRSRT STD

ECRWSS

US POSTAGE

STAMFORD, CT

PERMIT NO. 864

New Canaan Summer Enrich-

ment

East School

19 - ncps-k12.org

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