clms student-parent packet 2016 · student/parent pack 6th grade science camp 2019 may 7th to may...

Student/Parent Pack 6th Grade Science Camp 2019

May 7th to May 10th

Departing CLMS @ 8:30 am on Tuesday, May 7th Returning CLMS @ approximately 1:00 pm on Friday, May 10th

**Please read all information and fill out and return the “Health History” form,

“camp buddy” , t-shirt order form, and “district permission slips” no later than Friday, March 22nd, 2019**

All paperwork received after this date may not be able to choose camp buddy and be subject to incorrect sizing on camp t-shirt.

*** Please have any balances paid by Friday, April 12th, 2019 ***

**Please keep for your reference** (White)

C.O.D.E.S. School at Mile High Pines | 909-794-2824 | [email protected]

www.CODESschool.com | 42739 State Hwy 38, Angelus Oaks, CA 92305

PARENT’S GUIDE TO OUTDOOR SCIENCE CAMP

Frequently Asked Questions:

What are the Mile High Pines facilities like? The California OutDoor Education and Science School (or C.O.D.E.S. School) program is ran at Mile High Pines camp. The camp facil-ities have been in operation since 1945. The facilities have continuously been updated and modernized throughout the years. There are two separate camp facilities that can be used in conjunction or separately of one another for the outdoor education pro-gram.

The camp has several meeting rooms, many with fireplaces. It also provides a dining hall where all your child's meals will be served and prepared by a talented kitchen team of cooks and chefs. The activities at Mile High Pines varies depending on the outdoor edu-cation program deemed appropriate by your child's school or due to weather conditions. On site, there are two outdoor basketball and volleyball courts, and one full sized basketball and volleyball court inside of the Activities and Recreation Center (A.R.C.). The camp facility is walking distance to Jenks Lake and has a swimming pool on site. Also located on site is a rock climbing tower and zipline, archery practice, game tables, amphitheaters, horseshoes, and relaxation areas with picnic tables or under gazebos.

Most cabins are furnished with solid pine bunk beds and all mattresses are clean and comfortable. Cabins on Lower Pines have restrooms indoors, cabins on Upper Pines have large shared bath houses just steps away from eat cabin. Cabins are chosen by your child's school.

How will my child be supervised and by whom? Much of the hour-to-hour supervision will be done by the outdoor education cabin counselors that are provided by the school which your child attends. They will sleep in the cabins with students, lead students from activity to activity, and supervise them throughout the day. The teachers at your child's school are responsible for choosing, screening, and informing the counselors be-fore the week starts. The counselors that volunteer may be high school student's, college students, have prior counseling experi-ence or are parents themselves. Many outdoor education camp counselors return year after year because they enjoy their experi-ence so much.

What is the disciplinary system like? Different teachers and staff members have different disciplinary styles. Our outdoor education naturalists are instructed on the disciplinary "do's" and "don't's." We usually begin with some sort of verbal warning: "Christina, it is not OK to do that here." If the student continues the behavior, a timeout is usually given. Five minutes of sitting out of rec. time while 100 other students have their fun is not a 6th grader's idea of a good time. If a timeout is not effective, we may increase the timeout to ten or fifteen minutes. The teachers will be involved by this time, also.

If the behavior continues, a call home is in order, and you would need to pick up your child. We do not like to send students home, however, simply because the ones that will benefit most from the outdoor education program are those who may have problems working with other students or as a team in the cabins. Besides that, we understand that parents are busy with their daily routines and taking time to pick up a student can be very difficult.

The following breaches of discipline are grounds for immediate dismissal from the California OutDoor Education and Science School program: 1. Fighting2. Any activity that is inherently dangerous to self or others.3. Stealing4. Outright defiance.5. Intentionally destroying property.6. Unauthorized leaving of cabin7. Possession of illegal substances.8. Possession of any weapon.9. Other behaviors at the discretion of the Director of the California OutDoor Education & Science School.

What is the Daily Schedule like? We try to keep the students busy with activities that are productive and positive--classes, recreation time, evening activities, songs

****KEEP*****

(White)

PARENT’S GUIDE TO OUTDOOR SCIENCE CAMP CONTINUED...

and s'mores, skit night, meals, and cabin clean-up time. Students come to learn primarily life science, but also geology, orienteer-ing, team building, and social skills. All of this happens mostly in outdoor education classes with our trail teachers, but also in all of the activities simply because they are in a new situation learning new skills and dealing with new people. There is rest time sched-uled in the day, as well as recreation time. We strongly believe that students need "down time"-- time to play and be themselves so that they will have energy to put into more structured activities such as outdoor education classes and skit night.

What is the dining experience like? And, what if my child has special dietary needs? The professional food service team at Mile High Pines serves homestyle meals appropriate for youth during the week. We try to serve meals that most students would be familiar with. All meals are nutritious, plentiful and delicious. While student's are encour-aged not to waste, we also ensure that seconds are made available so that each student eats a filling amount. No additional food is needed whatsoever, unless a medical condition exists which would require it. Gum is simply not allowed. Vegetarians or Vegans: Please indicate to your child's school in advance (at least two weeks) if your child is a vegetarian/vegan etc... This will allow the kitchen staff ample time when creating and ordering food for the menu. Vegetarian students will be given an alternative at meals where there is no other protein substitute. For example: if we are serving hamburgers, a vegi-burger will be provided as an alternative. However, if we are serving pancakes, sausage, oatmeal, cottage cheese, cereal, and fruit (a typical breakfast), the sausage will not have an alternative as there are other protein options already provided. Gluten Free or Other Dietary Restrictions: Please indicate to your child's school in advance (at least two weeks) if your child has any dietary restrictions... This will allow the kitchen staff ample time when creating and ordering food for the menu. We will try to accommodate your child's needs and supplement the menu when necessary. However, in special cases you may have to supple-ment the menu by sending your student with food that we will keep and serve during meal times. If you would like supplement the menu yourself, you can call 909.794.2824 or and ask to speak with the food service manager to get the menu during your child's stay. Allergies: Please disclose all other allergies on health forms, and to your child's school prior to arrival.

Will I be allowed to call my child or have my child call me? What we have found during our outdoor education program (and this is true of most programs) is that when children are allowed to call home, this compounds the problem of homesickness, and the next thing that happens is that the student is on their way home. We strongly believe that we have a valuable outdoor educational experience to offer, and that to cut short a student's week is robbing them of that opportunity. Of course, not every call home will cause a domino effect leading to a trip home. But calls from parents or to home will pull students out of their outdoor education programmed activities, which are disrupting and ends up being a problem when several students need to call home using the office lines.

What, then, are your options? Send a letter or postcard the week before your child plans to attend, to ensure it arrives on time. We will deliver mail to the students daily, if you would like to have the letters delivered on separate days please indicate on the enve-lope (i.e., "Give to Jane on Tuesday"). Please write letters as follows:

Your child's name, Your child's school, CODES School at Mile High Pines P.O. Box 397 Angelus Oaks, CA 92305

If you would like you may call, (909) 794-2824 to speak with an outdoor education naturalist or your child's counselor to see how your child is doing. Please keep calls to a minimum. In the event of an emergency you may call to speak with your child.

What about illness and medications? All medications and health concerns should be listed on the forms provided by the teachers (which they will receive from us). Any medications are dispensed by our medical monitor, who is available throughout the day or by a teacher when medication is needed before bedtime. All of our outdoor education naturalists have a minimum of Red Cross CPR, and First Aid certificates.

What curriculum is provided for the students? Dr. Rick Oliver, our superintendent, has a Ph.D. in biological sciences. When developing the outdoor education program in 1993, he wrote curriculum for 5th, 6th, 7th and 8th grade according to the California Science Standards and Framework, which sets out what sort of material each grade level should be learning. The curriculum was originally developed for the Outdoor Science School at Mount Hermon in northern California. The curriculum has been updated and modified several times as appropriate or as scientific knowledge grows and to fit the ecosystem at Mile High Pines camp. Our outdoor education naturalists use the curriculum that is appropriate for the grade(s) the schools bring. If your child is in the 6th grade, you can expect to see 6th grade curriculum being used. Sometimes grades are mixed-- 5th and 6th or 7th and 8th. We usual-ly challenge them to go with the higher level curriculum in that case.

****KEEP****

(White)**Please keep for your reference**

Recommended Science Camp Packing List The following is a list of items you should pack. We have made some recommendations based on the

typical weather at CODES, please check the weather in Big Bear to get the clearest indication of weather at Mile High Pines to see if your child will need additional weather appropriate clothing. As always, it is best to pack clothing that can be layered.

___ Water bottle ___ 3 pairs of underwear

___ 4 pairs of socks ___ 2-3 pairs of long pants

___ 2 pairs of tennis shoes (please include sturdy shoes with support. No Ugg boots, Converse, or similar shoes.)

___ 4 t-shirts and 1 long sleeve shirts ___ Backpack

___ 1 sweatshirt and 1 jacket ___ 1 towel and face cloth

___ pajamas ___ 1 pair of slippers

___ Sleeping bag and pillow ___ Toiletries and lip balm

___ Sunscreen ___ Insect repellent (no aerosol cans, please) (no aerosol cans, please)

___ Pens, paper, pencils ___ Sunglasses

___ Flashlight ___ Disposable camera (optional)

___ Board shorts (campers may want to wear board shorts for canoe activity.)

** Please clearly label all items (bags) with student’s name and CLMS ** Please CLEARLY label all medications and place them in a zip lock clear plastic bag.

Unnecessary Items To avoid the loss of valuable items, we strongly suggest that the following items remain at home: cell phones, video games, computers, portable music devices, and other expensive electronics. Cell phones are not permitted at CODES, as reception is almost non-existent and we find it distracts from the learning environment. We cannot guarantee any of these items' safekeeping and will not replace them if lost. Please do not pack aerosol cans or any flammable items. Any food, candy, gum, and electronic devices will be collected upon arrival, as we do not allow these items in the cabins. We have found that students do not need more items than what is listed on the packing list.

**Please keep for your reference**

*****KEEP*****

(White)

LAKE ELSINORE UNIFIED SCHOOL DISTRICT

VOLUNTARY EXCURSION/FIELD TRIP NOTICE/PERMISSION

CLMS Please print student name Date of Birth School

has my permission to participate in the following voluntary activity/field trip:

6th Grade Science Camp – Mile High Pines

Departure Date & Time: May 7, 2019 8:30 am Return Date & Time: May 10, 2019 1:00 pm• I understand that the law states in California Education Code Section 35330, that the Lake Elsinore Unified

School District, its officers, agents and employees are held harmless from liability or claims which mayarise out of or in connection with my child's participation in this activity.

• In the event of illness or injury, I do hereby consent to whatever x-ray, examination, anesthetic, medical,surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment ofthe attending physician, surgeon, or dentist of the hospital or facility furnishing medical or dental services.

• Health Insurance company: Policy #:

• I fully understand that participants are to abide by all rules and regulations governing conduct during thetrip. Any violation of these rules and regulations may result in being sent home at the expense of theparent/guardian.

o I understand that all field trips begin and end at the school.

• Transportation will be provided by:

X District Bus

• IMPORTANT Note to Parent/Guardian: (1) All medications, excepting those which must be kept on thestudent's person for emergency use (EpiPen/Inhaler) must be kept and distributed by the staff; Iunderstand that it is my responsibility to provide all medications and the proper documentation for eachmedication. (2) If any medications are to be taken by student, a medication authorization MUST beprovided for each medication including over the counter medication. All medication will be provided bythe parent in the original container with student name, medication name, dosage schedule and route,physician’s name and date of expiration of prescription.

Please List medications here:__________________________________________ (3) If your child has aspecial medical problem, please attach a description of that problem.

Note: All student health information will be kept confidential per FERPA guidelines.

Parent/Guardian Signature Date:

Address Telephone

**Please return to your science teacher**

E 6153(b)

(Green)

Student Name: _______________________________ Science Teacher: Lessley Mobley Quinn Barackman

Lake Elsinore Unified School District Student Overnight Activity Agreement

Students and parents will be asked to read, agree and sign the following form to participate in any overnight field trip, retreat, competition or activity connected with the Lake Elsinore Unified School District. The Lake Elsinore Unified School District believes that these guidelines should be followed to ensure that all students have a safe and enjoyable activity. The student agrees to the following:

1. I am responsible for my own actions and will conduct myself in an appropriate manner at all times.2. Since this is a district and school-sponsored activity, I will follow ALL district and school rules. I understand

that all district and school rules will be enforced and appropriate discipline will be taken at school if any districtand/or school rules are broken.

3. I agree to attend and participate in ALL scheduled activities and in the case of a problem; I am to clear myabsence with my advisor in advance.

4. I agree to remain on the premises or with the group at all times; anyone leaving the “premises or site” or groupwithout permission will be sent home immediately at the parent’s expense and notice will be sent to theprincipal.

5. Out of respect for others and to allow everyone to feel safe, I agree to stay in my own room and out of the roomsof others. IF BOYS ARE FOUND IN GIRLS ROOMS OR GIRLS IN BOYS ROOMS, students will be senthome at the parents’ expense and notice will be sent to the principal.

6. I will abstain from the use or possession of alcohol, tobacco, and other drugs while attending the activity. Iunderstand that if alcohol, tobacco or other drugs are found in a room, everyone in that room may be subject todisciplinary action. I also understand that alcohol, tobacco or drug use will be treated the same as if I were onschool grounds.

7. I agree to abide by all curfews.8. If I have a cell phone, beeper or electronic media device, it will stay off during the activity and the district will

not be responsible for any loss or theft of these devices.9. I understand that in the event that I am staying in a hotel room, any additional expenses, such as telephone

charges, room service, etc. will be my responsibility and will not be paid by the school.10. I understand that violations of any of the above stated terms and conditions will subject me to immediate

disciplinary action and I will have no right of appeal until returning from this trip. My parents/guardians will benotified and if necessary, will be responsible for my transportation home.

11. I have read and reviewed the LEUSD Discipline Policy provided.

As a committed participant in this overnight school activity, I understand the rules and regulations as stated above.

Student Signature__________________________________________________ Date____________

As a parent, I understand the rules and regulations as stated above and will support the adult supervisors in the responsibility and judgment of caring for my child.

Parent Signature__________________________________________________ Date____________


E 6153(g)

(Green)


C.O.D.E.S. School at Mile High Pines | 909-794-2824 x102 | [email protected] | 42739 State Hwy 38, Angelus Oaks, CA 92305

1

Participant’s Name: _____________________________ School/Organization:____________________________

Page 1 of 7

RELEASE WAIVERS & HEALTH HISTORY SCREENING

This form is to be completed by ALL individuals attending camp: Students, Teachers, and Chaperones.

GENERAL RELEASE WAIVER:

The undersigned, or on behalf of said minor, has asked Mile High Pines Camp (hereinafter “MHP”) to be allowed to

participate in activities offered at MHP. Activities may include but are not limited to: archery, rock climbing, low ropes

course, gaga ball, sports, hiking, zipline, kayaking or canoeing, swimming. The undersigned acknowledges and

understands that: (1) MHP activities involve physical exertion and other risks, (2) the possibility of risk of injury to

individuals participating or observing the activities, including but not limited to permanent disability including blindness,

or death does exist, (3) the need/requirement to participate in the activities in accordance with the rules that are given

and to follow directions given by any staff member, (4) it is each participant’s responsibility to wear any and all safety

gear deemed necessary by MHP, (5) a participant’s physical and mental condition will enable him/her to participate

safely in the activity. The undersigned, or on behalf of said minor, hereby waves and releases any and all claims,

demands, actions, causes of action and rights (contingent, accrued, inchoate, or otherwise), defends, and holds MHP

harmless from and against any and all claims, liabilities, expenses, damages, losses, cause of action, and suits (including,

without limitation, attorney’s fees and costs) arising out of, or in any way related to, the participation in activities at

MHP, whether caused by MHP’s active or passive negligence or otherwise.

IMAGE RELEASE WAIVER:

The undersigned also gives permission to MHP to use any photographs and video and audio of him/her, or said minor,

for any promotional materials, including the MHP web site and social media postings, without expectation of

compensation, including, but not limited to, any royalties, proceeds, and/or other benefits derived from such

photographs, videos, or audio recordings.

MEDICAL RELEASE WAIVER:

The undersigned also gives permission to the Medical Monitor to provide or arrange necessary transportation and to

secure and administer proper treatment as needed and gives permission to release any records necessary for insurance

purposes. They may also give information as necessary to all those who may be in care of the student or adult at camp.

The camp first aid personnel/director/or teacher may give pain relievers to your child for minor illness com-plaints. They

may apply calamine lotion, or equivalent, for plant-related rash reactions. Allergy medication, basic first aid, and other

care based on the level of training may be given. Camp personnel might not call parents before treating for minor

ailments during your child’s camp stay. Some examples where you may not get a phone call may include: headaches,

cold symptoms, ministration cramps, minor cuts, minor bruising, homesickness, use of as needed medications, and

similar incidents. I understand that Education Code 49480 gives the camp and school medic with parent consent (given

by signing this waiver), permission to communicate with the physician and counsel with the science school personnel

regarding possible effects of medication.

Parent/Guardian Signature (for all 3 waivers): _________________________________________ Date:______________

Canyon Lake Middle School

**Please return to your science teacher** (Yellow)

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Participant’s Name: _____________________________ School/Organization: ____________________________

EMERGENCY CONTACT INFO: Page 2 of 7

Participant’s Name: _______________________________ Birthdate (mo/day/year): ________________________

Gender: Male Female Age at Date of Attendance: _______________________

School: _________________________________________ Camp Dates: ___________________________________

Primary Emergency Contact: Mr. Mrs. Ms. Dr. (required): ___________________________________________________

Relationship to Participant: _________________________ Day Phone:____________________________________

Evening Phone: ___________________________________ Email: ________________________________________

Address: ___________________________________________________________________________________________

City/State/Zip: ______________________________________________________________________________________

Secondary Emergency Contact: Mr. Mrs. Ms. Dr. __________________________________________________________

Relationship to Participant: _________________________ Day Phone: ____________________________________

Evening Phone: ___________________________________ Email: ________________________________________

Address: ___________________________________________________________________________________________

City/State/Zip: ______________________________________________________________________________________

HEALTH HISTORY SCREENING:

1. Does your child have any physical limitations? If so, please describe:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

2. Is your child taking any medicine (e.g. prescriptions, over-the-counter medication, vitamins) with him/her to camp?

NO YES *If you answered YES, please fill out the Medication Forms (pg. 5-6).*

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

3. List any physical conditions or difficulties that your child has, and give specific instructions for care. Please include

health conditions such as diabetes, epilepsy, mobility concerns, etc.

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________



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HEALTH HISTORY (cont’d): Page 3 of 7

4. Please list all of your child’s dietary considerations:

Severe peanut allergy (airborne)* Moderate peanut allergy (ingested) Mild peanut allergy (No Epi-pen)

Vegan* Vegetarian Gluten-Free Strawberry Allergy Shellfish Allergy

Soy Allergy* Lactose Intolerant Other: ___________________________________________________

*MHP cannot avoid all allergens in entirety, but strives to keep a nut-free main menu. Nevertheless, some of our

products are manufactured in factories that also manufacture nut products. Vegans and those with soy allergies should

bring additional snacks/meals to be kept in the main kitchen and served during scheduled meals. It is the

parent/guardian’s responsibility to ensure that the school/teacher has notified CODES of their child’s dietary restrictions

at least 1 month prior to arrival.

4a. Please specify how the above dietary considerations will affect your child:

My child will need substitutes for every meal where the item(s) above is served.

My child will self-moderate and parents/guardians will pack snacks to be eaten at meals if needed.

My child will self-moderate and will not need substitutes for meals.

Other: _________________________________________________________________________________________

5. Date of last Tetanus booster: ________________________________________________________________________

MHP advises that participants have a Tetanus booster within last 10 yrs, or the period of time advised by your physician.

6. Date of last Physical: _______________________________________________________________________________

To better serve your child and to protect your child’s privacy, the following information is needed:

7. Do you consider your child to be in good health overall? YES NO

8. Please check the box if your child is or has suffered from the following:

Allergies Ear Trouble Tuberculosis Asthma Heart Disease Convulsions

Wears glasses/contact lenses Eye Trouble Hernia Bronchitis Menstrual Cramps

Stomachaches Kidney Disease Rheumatic Fever Homesickness Sleepwalking

Any other serious illness or operations Child has been exposed to someone with a communicable disease

Bed-wetting (please provide your child with GoodNites/bedwetting undergarments to avoid embarrassment)

Please explain any items checked:______________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

8. Will your child have a birthday during their camp stay? Yes No Day: ______________________



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HEALTH HISTORY (cont’d): Page 4 of 7

9. Is there anything else you would like us to know about your child? __________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

10. Please note any health problems or illnesses your child has experienced in the month prior to attending CODES (e.g.

flu, colds, asthma attacks, lice infestations, etc.)

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

VERY IMPORTANT: If your child has an allergy that results in anaphylactic shock, please send 2 Epinephrine kits. If the

kits go unused, they will be returned to you. If your doctor’s orders are to use Benadryl in conjunction with an EpiPen,

please send both to camp with your child.

ACKNOWLEDGEMENT & RELEASE OF LIABILITY:

I understand that should my child be sent home due to illness, injury, disciplinary issues, or any other reason, no amount

of the fees paid to Mile High Pines for my child to attend CODES School shall be refunded if my child did not withdraw

from the program at least 2 weeks in advance of the camp start date.

I understand that my child cannot attend camp if his/her primary residence is currently lice or bed bug infested or has

any other pest infestation, or if my child is recovering from an infectious disease or illness. I further understand that if

my child becomes ill, contracts, or suffers from conditions or symptoms as a result of another student unknowingly or

knowingly bringing pests, infections or disease to camp, CODES and Mile High Pines is not liable.

With the understanding that a certified teacher from my child’s school will be on site and available, I give permission for

my child to attend CODES School at Mile High Pines, and to participate in the activities involved. Further, I give my

permission for the Camp Director or designated camp staff to obtain qualified medical/surgical assistance, in the event

of an accident or illness, to my child with the understanding that I will be contacted as soon as possible if any emergency

medical/surgical attention is necessary.

Parent/Guardian Signature: ______________________________________________ Date: _____________________



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MEDICATION FORM: Page 5 of 7

This form is to be completed by ALL individuals who are bringing medications to camp.

STEP 1: Place the MEDICATION and this FORM in a clear Ziploc bag.

STEP 2: Turn the bag in, to your child’s teacher or School Health Professional.

STUDENT INFORMATION DOCTOR/PHYSICIAN INFORMATION

Name: Name:

School Name: Phone:

Date of Camp: Doctor’s Stamp or Address:

Parent/Guardian Name:

Relationship to Student:

Phone Number:

According to Education Code 49423 a signed order from your child’s physician and the parent/guardian is REQUIRED if:

a) The prescription on the bottle/box/tube is in a language other than English.

b) The prescription on the bottle/box/tube is does not match the dosage that parents would like administered.

c) The medication will not be used for its prescribed purpose. Please refrain from sending this type of medication.

d) The medication is not intended for use based on the age of your student. Please refrain from sending this type

of medication.

No doctors note is needed if the medication is over-the-counter AND intended for children, however, please DO NOT

send “as needed over-the-counter medication”. Camp has pain relievers, allergy medication, and cold medication in

stock. Furthermore, unlabeled medication CANNOT be administered and loose medication (without packaging) WILL

NOT be administered.

Education Code 49480 gives the camp and the school’s Health Professional with parent consent, permission to

communicate with the physician and counsel with CODES & MHP personnel regarding possible effects of medication.

Please sign below, your signature gives permission for MHP’s Medical Monitor, Director, responding staff, and/or your

child’s teacher to assist in carrying out the medical instructions indicated or providing medical care. Your signature also

indicates your consent as required in the above Education Code Sections 49423 and 49480.

Parent/Guardian Signature: ___________________________________________ Date: _______________



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Page 6 of 7

MEDICATION INFORMATION

(We request that only ESSENTIAL medicine be sent to camp)

MEDICATION DOSAGE

SCHEDULE

(Indicate when to give

the medication)

REASON FOR MEDICATION SELECT A CATEGORY FOR EACH

MEDICATION

All medication

including over-the-

counter medications

& vitamins must be

in the original

package/box/bottle

and NOT EXPIRED.

Bef

ore

Bre

akfa

st

Bef

ore

Lu

nch

Bef

ore

Din

ner

Bef

ore

Bed

tim

e

As

Nee

ded

Provide any needed

background info about the

medication.

Over-the-Counter

Medication (Must

be approved for

the student’s age).

Rx

Prescription

Medication

Example:

Amoxicillin 500mg

1 pill

3x/day

(oral)

X X X

Antibiotic, after dental

surgery. He may complain

of pain, please give OTC

pain reliever as needed.

My child has my permission to take the listed medications to camp and for camp first aid personnel, the Director or my

student’s teachers to assist and/or allow my child to take/apply these medications in addition to those below in the case

of illness:

a) Pain relievers for minor illness complaints.

b) Calamine lotion, or equivalent, for plant-related rash reactions.

c) Allergy medications, basic first aid, and other care based on the level of training of camp staff may also be

administered.

Camp personnel will give care in accordance to their training and may not call parents before treating for minor

ailments. Such instances include but are not limited to: headaches, cold symptoms, menstrual cramps, minor cuts, minor

bruising, homesickness, use of “as needed” medications, etc.

Those campers that have prescribed medication to take while in residence at the camp must abide by Education Codes

49423 and 49480 which state that school personnel must be given instruction as to method, amount, frequency, and

condition for which it is indicated. Medication must be turned in to school personnel prior to arrival.

Parent/Guardian Signature: ___________________________________________ Date: _______________



7

Parent Check List for Medications:

All medications are appropriate for my child’s age or have a Physician’s note.

All medications are clearly marked with my child’s name.

All medications are in their original packaging with dosage listed.

All medications are in English and legible.

All medical forms are in English and legible.

All medical concerns have been communicated with school personnel.

All medications are needed daily or in emergency situations.

All of my child’s medications are in a plastic bag (Ziploc) with my child’s name on it.

NOTE TO ALL PARENTS:

We would like to serve all children quickly and effectively, however, sometimes parents overload our medical center

with medications or non-medications that they would like their child to receive at camp. These slow down the care for

students who have serious medical needs. Please limit or avoid sending: daily vitamins, essential oils (they will need a

Physician’s note for these), over-the-counter generic pain reliever (we have pain reliever onsite), Pediasure or other

dietary supplements (unless snacks are needed for dietary restrictions), allergy medication for students who rarely have

seasonal allergies (unless they need it daily or if they have a severe allergy), we do have seasonal allergy medication for

students who may have occasional needs or who have not experienced allergies until camp, medication for car sickness

especially if they have no known history of car sickness.

Keep in mind, you will see your child on Tuesday before they go, and on Friday when they come home. So please ask

yourself if your child can go without the items listed above for two days before you decide to send it to camp.


YOU: Circle one: boy or girl (*needs to be same as below)

Your Name:__________________ _______________________ First Name Last Name

Your Science Teacher’s Name: __________________________________

YOUR Buddy: Circle one: boy or girl (*needs to be same as above)

His/Her Name:__________________ _______________________ First Name Last Name

Their Science Teacher’s Name: __________________________________


Camp Buddy Request Form

(Blue)


Included

Student’s Name:__________________ _____________________ (Print First Name) (Print Last Name)

Camp To shirt : Included Camp Tp shirts *adult sizes

Size: ___ xs (youth lg) ___*sm ___*med ___*Lg ____XL


2019 6th Grade Science Camp T-shirt


(Pink)

Note: T-shirts & Sweatshirts are ADULT sizes.

Please return to **CLMS Bookkeeper @ ASB Window**

**Optional EXTRA CAMP STUFF

Quantity: ____ $6 sm (8x10) ______ $10 Lg (12 x 18)

2019 6th Grade Science Camp Order Form

Student’s Name: __________________ Last Name: _________________

Extra T-shirt ($10)

Size & Quantity: ___ xs (youth lg) ___*sm ___*med ___*Lg ____XL

Extra Long Sleeve Tp shirt ($15)


Camp Sweat Shirt ($25)


Camp Group Picture

(Goldenrod)


Note: T-shirts & Sweatshirts are ADULT sizes.

clms student-parent packet 2016 · student/parent pack 6th grade science camp 2019 may 7th to may...

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