RETURN TO SCHOOL PACKET Forms contained in this packet should be completed, only if applicable, signed, and brought with the student to registration on August 12, 13, or 14. If unable to attend registration on one of these dates, students should call the Student Services Office at (262) 534-3189 to arrange a time to hand in emergency cards, pick up class schedules, pay fees, and purchase workbooks. Picture makeup day is Friday, August 30 for all late registrants, and school pictures will be taken during the lunch hour on that day.

Students will NOT be allowed to complete the registration process if they do not have their purple Emer-gency Contact Card with them. There are some areas on these cards that do not pull from our database. Please be sure to fill in the following areas: Race & Ethnicity; Student Lives With; Extra Mailing for 2nd Parent (i.e., who wishes to receive mailings); and Health Information. Both the FRONT AS WELL AS THE BACK of the Emergency Contact Card require a student and/or parent signature. In addition, please carefully examine all information on the cards and highlight any changes that have to be made. The areas highlighted will be the only information that the registration personnel will change in PowerSchool. Please review your emergency contacts also since these are the only persons that school personnel will contact when it becomes necessary to do so. Make sure that the emergency contacts are the most appropriate persons to call if we cannot get in touch with either parent.

For additional information pertaining to any of the enclosed items, please refer to the Wolverine Report newsletter that is also enclosed with this mailing.

Forms attached to this packet, which are to be returned to school if applicable, include:

Parents' Day R.S.V.P. - if parent/guardian plans to attend

Student Parking Agreement - if student wishes to park in upper lot (some restrictions apply)

1:1 Technology User Agreement- All students must sign and return

School Medication Policy/Medication Administration Form - if student requires medications during school hours

Allergy Action Plan - if student has severe allergies and/or requires EpiPen

Free/Reduced Lunch Application - if applicable

Athletic and Activities Permission Slip - if student plans to participate in a sport, club, or activity. Note: if partici-pating in a sport, additional forms are needed (concussion and physical) and are available in the Co-Curricular Office.

Student Emergency Contact card (purple) - MUST be returned at registration. Please VERIFY that all informa-tion on the card is accurate and current.

If you have questions relating to any of these forms, please contact Waterford Union High School at (262) 534-3189.

WATERFORD UNION HIGH SCHOOL2019-2020 Registration Information

NOTICE OF NONDISCRIMINATION POLICY - ACCESS TO EQUAL EDUCATIONAL OPPORTUNITY

The Waterford Union High School Board of Education is committed to providing an equal educational opportunity for all students in the District.

The Board does not discriminate on the basis of race, color, religion, national origin, ancestry, creed, pregnancy, marital status, parental status, sexual orientation, sex (including transgender status, change of sex or gender identity), or physical, mental, emotional or learning disabilities (“Protected Classes”) in any of its student programs and activities.

The Board is also committed to equal employment opportunity in its employment policies and practices as they relate to students. The Board’s policies pertaining to employment practices can be found in Policy 1422, Policy 3122, and Policy 4122 – Nondiscrimination and Equal Employment Opportunity.

Any inquiries or concerns related to nondiscrimination should be addressed to appropriate school district personnel. Should there be rounds for a complaint, a written statement of the complaint shall be prepared by the complainant, and directed to the appropriate individual or position holder listed below.

Discrimination complaint forms can also be obtained from the offices listed below as well as from the office of the super-intendent, 507 West Main Street, Waterford, WI 53185.

Reporting ProceduresStudents, parents and all other members of the School District community are encouraged to promptly report suspected violations of this policy to a teacher or administrator. Any teacher or administrator who receives such a complaint shall file it with the District’s Compliance Officer at his/her first opportunity.

Students who believe they have been denied equal access to District educational opportunities, in a manner inconsistent with this policy may initiate a complaint and the investigation process that is set forth below. Initiating a complaint will not adversely affect the complaining individual's participation in educational or extra-curricular programs unless the com-plaining individual makes the complaint maliciously or with knowledge that it is false.

Compliance Officer(s)The Board designates the following individual(s) to serve as the District's 504 CO(s)/ADA Coordinator(s) (hereinafter referred to as the "COs").

Daniel F. Foster, Principal Nicole Werner, Director of Student Services (262) 534-3189, Ext. 7504 (262) 534-3189, Ext. 7516 100 Field Drive, Waterford, WI 53185 100 Field Drive, Waterford, WI 53185 Email: dfoster@wateforduhs.k12.wi.us Email: nwerner@wateforduhs.k12.wi.us

118.13 Wis. Stats.

PARENTS’ DAY FRIDAY, SEPTEMBER 27, 2019

Dear Parents and Guardians, As you know the school year will soon be in full swing. Once again, Waterford Union High School will be hosting Parents’ Day. You are invited to attend the school’s annual Parents’ Day to meet your student’s teachers and to see for yourself what Waterford Union High School is all about. On Friday, September 27, 2019, we would like to invite you to attend school with your son or daughter. Throughout the day, you will have the opportunity to meet with an administrator and/or guidance counselor during study hall. The intent of Parents’ Day is for students to share a day with their parents. While parents are welcome, brothers, sisters, or grandparents should not attend unless they are their legal guardians. Furthermore, parents with young children who would like to participate will need to make alternative arrangements for day care The day will begin with a complimentary breakfast for you and your student(s) at 6:45 AM in the Commons. Students must be with a parent or guardian in order to attend the breakfast. First hour begins at 7:25 A.M. sharp, and because September 27 is an early release day for students, the last period of the day will end at 12:00 P.M. We ask that parents park on the neighboring streets as the Village has agreed to ease its parking restrictions on that day. The administration, staff members, and students hope that you will be able to attend as we look to you to make Parents’ Day a success! In order for us to accommodate everyone for breakfast, we ask that if you are able to attend please R.S.V.P. by Friday, September 20 by returning the bottom portion of this letter to the main office. We look forward to seeing you at Parents’ Day! Sincerely, Waterford Union High School Staff & Students --------------------------------------------------------------------------------------------------------------------------------------- Yes, I (we) will be attending Parent’s Day on Friday, September 27, with my (our) son/daughter Name of Student(s):________________________________________________________________________ Name of Parent(s) attending:_________________________________________________________________

Total number attending breakfast - including student(s): (6:45 AM - 7:20AM): ______ *Must have parent present to attend breakfast

OR

Number of Parent(s) attending school day only: _______

Please Return by September 20, 2019 Waterford Union High School Main Office

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WATERFORD UNION HIGH SCHOOL STUDENT DRIVING AGREEMENT

2019-2020

DRIVING TO SCHOOL IS A PRIVILEGE WHICH IS GRANTED ONLY TO THOSE STUDENTS WHO ARE WILLING TO ABIDE BY NECESSARY RULES. TO KEEP THIS PRIVILEGE, STUDENTS SHOULD KNOW AND ABIDE BY THE FOLLOWING: 1. Any change of vehicle or license must be reported to main office. 2. Parking is on a first come basis. There are no assigned spots. 3. Driving permit tags must be hung on the rear view mirror. 4. Annual parking permits cost $50, historically. Since all permits will be issued through the lottery system due to building construction, all permits will be prorated based on the duration of issuance. 5. If a student is determined truant from any class period, his/her parking permit may be revoked without refund. 6. Violations of rules will result in suspension of driving privilege and revocation of parking permit for the remainder of the year, without refund. For non-senior drivers: any student who has a parking issue will lose one status level for senior year. Status levels are as follows: automatic, lottery, ineligible. 7. Parking permits will be issued on a priority basis: A. Students enrolled in school-sponsored off-site programming to include Work Place Literacy, off-campus college courses, or other work release programs B. Students with senior status C. Students with junior status go into the lottery 8. NO STUDENTS WILL BE ALLOWED TO GO TO THEIR CARS DURING SCHOOL. 9. The driver of the vehicle will be held responsible for all materials in his/her vehicle. Any vehicle parked on school property is subject to search. 10. Permits are non-transferable and cannot be sold to another student. Seniors who graduate early must surrender their parking permit to the main office. Students can receive a pro- rated refund upon return of the permit. 11. All student fees (current and past due) must be paid in full prior to purchasing a parking permit.

If there are too many applications for parking permits, a lottery system will be used. Juniors may apply at registration and will receive permits after school starts if they are selected during the lottery process. There are an additional 170 parking spaces in the lower lot located by the baseball field. Any student may park in the lower lot without a permit, yet the vehicle is still subject to search and school expectations. Changes to physical facilities or programming may result in alterations to the agreement. Students will be notified of changes.

Waterford Union High School Student Driving Agreement

2019-2020

BRING THIS AGREEMENT TO REGISTRATION. IT MUST BE SIGNED AND ALL INFORMATION FILLED OUT IF A STUDENT WISHES TO PARK IN THE SCHOOL UPPER WEST LOT. Student’s Name: ___________________________________ Grade: __________ Make of vehicle: ____________________ Model of vehicle: __________________ Color of vehicle: ____________________ License plate number: ______________ I understand I must properly display my permit every time I choose to park in the assigned lot. If I do not have a properly displayed permit in the vehicle, I cannot park in the upper lot. I further understand my failure to do so may result in the following consequences: Warning, temporary forfeiture of parking permit, office referral, permanent forfeiture parking permit or referral to law enforcement. I have read, understand, and agree to abide by all the above rules. Student Signature: _________________________________ Date: __________________ I desire my son/daughter be issued a permit to park on school grounds. I understand he/she must abide by the attached rules or the permit will be revoked without refund. Parent/Guardian Signature: ___________________________ Date: __________________ NOTE: Waterford Union High School is not responsible for any traffic tickets, violations or vehicle damage. Students will be prosecuted for traffic or parking violations by the village or county police. Parking in the school lot without a permit or in an unassigned area may result in a ticket.

Parking Permit Number: ______________ 

Waterford Union High School  1:1 User Agreement   

The following information must be completed annually. Failure to complete the following information may delay your access to using district-issued devices or may result in disabling of your district-issued device.

Student

 I understand that I will be/have been issued a computer for educational use and that I am responsible for proper care, handling, security, storage and use of the device. I have read and agree to comply with terms and expectations in the Waterford Union High School 1:1 Handbook. I understand that my failure to follow the information and expectations outlined in this document may result in disciplinary and/or financial consequences. Student Name (Print)_________________________________________________ Student Signature ____________________________________ Date __________

Parent/Guardian

I have read and discussed the Waterford Union High School 1:1 Handbook with my child. As the parent or legal guardian of the student signing above, I understand that my child’s failure to follow the information and expectations outlined in this document may result in disciplinary or financial consequences. Parent/Guardian Name (Print) ________________________________________ Parent/Guardian Signature ____________________________ Date _________ The Waterford Union High School 1:1 Handbook is available by viewing it directly online at http://www.waterforduhs.k12.wi.us/

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School Medication Policy   1. Medications brought to school that do not meet the following requirements will not be given by school

staff.

2. All prescription medications require a signed Medication Administration Request Form. These forms are available in the school office and on the school health/nurses website. Any non-prescription medications to be administered at school for more than 10 consecutive days require a Physician signature. Parents will have up to 48 hours to submit completed authorizations to the school.

3. Parents can sign a 10-day Medication form for a non-prescription medication and can sign a 48 hour Medication form for prescription medication. If a non-prescription medication needs to be given for more than 10 days, a Medication Administration Request Form is needed. Also, if a prescription medication is needed for more than 2 days, a Medication Administration Request Form is also needed. Medication Administration Request Forms can be faxed to a physician if the fax number is supplied to the school.

4. Medication to be given at school must be in the original container and must have: A. Child’s full name on the container

B. Name of drug on the container

C. If the medication is a prescription drug: 1. Pharmacy name and phone number 2. Prescription number 3. Physician’s name

No medication is to be sent to school in baggies or envelopes.

5. A signed Medication Request Form from the parent/guardian must accompany the medication. A signed parent note can suffice for up to 48 hours but must include the child’s full name, date, time and days to be given and reasons for use.

6. Supplies of non-prescription medications (Tylenol, Advil, Midol, etc.) will not be kept at school for occasional use by the student throughout the year unless a physician authorization is received.

7. All medication will be kept in a locked container or cabinet in the school office. Students must bring all medication to the office at the start of the school day and may not be kept in backpacks or lockers. The student will be supervised while taking the medication by designated school personnel at a time conforming to the indicated schedule on the Medication Administration Request Form. Self-administered medications are an exception to this and require specific consent.

8. A medication record will be kept for each student receiving medication at school with the exception of self-administered medications

9. Parents must notify the school when a drug is discontinued. A physician’s order is required for any prescription medication dose change. Verbal medication orders can only be taken by a registered nurse.

10. New Medication Administration Request Forms must be received at the start of each school year.

11. Parents are asked to pick up all medication on the last day of school. All medications will be disposed of ten days after the end of the school year.

12. All medications to be administered during the school hours are to be given through the office by trained school staff. The exception to this rule will be self-administered medication, which will be allowed with parental and physician consent.

13. Students are responsible to report for medication at the appropriate time. If the student does not show and the medication is not administered for three consecutive doses or three or more times in a two-week period, the parents will be notified. Students are to report to the office for their medication between classes at the middle and high schools.

14. Medication errors will be documented and the following persons will be notified immediately: school nurse, parent/guardian of student, school administrator and student’s physician.

WATERFORD UNION HIGH SCHOOL MEDICATION ADMINISTRATION REQUEST FORM

Name of Student: _______________________________ Date of Birth: ________________ School: _______________________________ School Year: ___________ Grade: ________ Physician’s Name:_____________________________ Physician’s Phone: _________________ Phone number where Parent/Legal Guardian can be reached during school hours:__________________

PARENT/GUARDIAN AUTHORIZATION

I, the parent/guardian of the above named student, have read the school’s medication policy and request the medication listed below be administered to my child at school. I understand that qualified, designated persons will be administering the medication. I will notify the school immediately if there is a change or cancellation of the medication. The School District has my permission to contact the prescriber in regard to the medication being prescribed. An over-the-counter medication can be given for 10 days or less with a parent signature. If an over-the-counter medication is to be given for greater than 10 consecutive days, a physician’s signature is required below or the medication will not be given. Prescription medications will not be given for more than 2 days unless this form is completed and signed by both the parent and physician. ____________________ ___________________________________________________________ Date Signature (parent/guardian)

BRONCHIAL INHALERS AND EPIPEN: Provisions for Self Administered Medications at School: 1) No documentation of self administered medication will be kept by the school. 2) The school is not responsible for the safeguarding of self administered medication. 3) The school nurse will attempt to meet with each student annually who self administer medications. 4) Self administered medications also require a parent and physician signature and new paperwork must be received each year. My child ____CAN ____CANNOT carry and self-administer the prescribed ____ INHALER or ___EPIPEN.

____________________ ___________________________________________________________ Date Signature (parent/guardian)

Medication at School Dosage Time(s) Side Effects Reason for Med.

PHYSICIAN AUTHORIZATION

I authorize the administration of the medication listed directly above to the student named on this form. I agree to be contacted by the School District as needed regarding the medication.

PRN MEDICATIONS (If applicable) Indications for use: _____________________________________________________________________ Plan following administration (if needed) ____________________________________________________

BRONCHIAL INHALERS AND EPIPENS (If applicable) It is my professional opinion that the student named above ______CAN ______CANNOT carry and self- administer the prescribed ______INHALER or ______EPIPEN. He/she has been instructed in and understands the purpose and appropriate use of the medication. _______________ ________________________________ __________________________________ Date Signature of Physician Physician’s Name (Printed)

___________________________________________________________ ________________________ Physician’s Address City State/Zip Code Phone

***ONLY FOR STUDENTS WITH AN EPIPEN***

WATERFORD UNION HIGH SCHOOL ALLERGY ACTION PLAN

Date: ______________ School: __________________ Grade: _________

Student’s Name: _______________________________ Date of Birth: ________________

ALLERGY TO: ______________________________________________________________

** STEP 1: TREATMENT **

Symptoms: Give Checked Medication: (To be determined by physician authorizing treatment) * If insect bite/sting occurs, but no symptoms: Epinephrine Antihistamine Other * If food allergen has been ingested, but no symptoms: Epinephrine Antihistamine Other * Mouth Itching, tingling, or swelling of lips, tongue, mouth Epinephrine Antihistamine Other * Skin Hives, itchy rash, swelling of the face or extremities Epinephrine Antihistamine Other * Gut Nausea, abdominal cramps, vomiting, diarrhea Epinephrine Antihistamine Other * Throat° Tightening of throat, hoarseness, hacking cough Epinephrine Antihistamine Other * Lung° Shortness of breath, repetitive coughing, wheezing Epinephrine Antihistamine Other * Heart° Weak pulse, low blood pressure, fainting, pale, blueness Epinephrine Antihistamine Other * Other° ____________________________________________ Epinephrine Antihistamine Other The severity of symptoms can quickly change. °Potentially life threatening

DOSAGE Epinephrine: inject intramuscularly (circle one): EpiPen® EpiPen® Jr. Twinject™0.3mg Twinject™0.15mg Antihistamine: give _______________________________________________________________________________________

medication/dose/route Other: give ______________________________________________________________________________________________

medication/dose/route

** STEP 2: EMERGENCY CALLS **

1. Call 911. State that an allergic reaction has been treated, and additional epinephrine may be needed. 2. Dr._______________________________ at ___________________ 3. Emergency contacts: __________________________ _________________________ _________________________ Name/Relationship: Phone Numbers __________________________ _________________________ _________________________ Name/Relationship: Phone Numbers EVEN IF PARENT/GUARDIAN CANNOT BE REACHED, DO NOT HESITATE TO MEDICATE OR TAKE CHILD TO MEDICAL FACILITY! Parent/Guardian Signature: ___________________________________________ Date: ___________________________ Physician’s Signature: _______________________________________________ Date: ___________________________ Physician’s Name (Printed) :_______________________ Address: ___________________ State/Zip ________________ * Adapted from The Food & Anaphylaxis Network. Used with permission.

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HOW TO

 APPLY FOR FREE M

ILK for 2019‐20 School Year Please u

se these in

structio

ns to

 help

 you fill o

ut th

e applicatio

n fo

r free milk. Yo

u only n

eed to

 submit o

ne ap

plicatio

n per h

ouseh

old, fo

r all child

ren in

 your h

ouseh

old who 

attend sch

ool at W

aterford Union High

 School. Th

e applicatio

n m

ust b

e filled out co

mpletely to

 certify your ch

ildren

 for free m

ilk. Please fo

llow th

ese instru

ctions in

 order. If at 

any tim

e you are n

ot su

re what to

 do next, p

lease contact M

aryann Pike, W

aterford Union High

 School D

istrict Office, b

y phone (2

62) 5

34‐9059, Ext. 7

507 or b

y email at 

mpike@

waterfo

rduhs.k1

2.wi.u

s.  

PLEASE USE A PEN

 (NOT A PEN

CIL) WHEN

 FILLING OUT TH

E APPLICATION AN

D DO YO

UR BEST TO

 PRINT CLEARLY. 

STEP 2: DO AN

Y HOUSEH

OLD

 MEM

BERS CURREN

TLY PARTICIPATE IN FoodShare, W

‐2 Cash Benefits OR FD

PIR? If anyone in your household (including you) currently participates in one or m

ore of the assistance programs listed below

, your children are eligible for free milk: 

Th

e Supplem

ental N

utritio

n Assistan

ce Program

 (SNAP) o

r FoodSh

are.   

Tem

porary A

ssistance fo

r Need

y Families (TA

NF) o

r W‐2 Cash

 Ben

efits. 

Th

e Food Distrib

utio

n Program

 on In

dian

 Reservatio

ns (FD

PIR). 

A)  If no one in your household participates in any of the above listed program

s:  

Leave

 STEP 2 blan

k or ch

eck “No” an

d go

 to STEP 3. 

B)  If anyone in your household participates in any of the above assistance programs:  

Write a case n

umber an

d th

e nam

e of th

e program

 you or an

y mem

ber o

f the h

ouseh

old particip

ates for 

FoodSh

are, W‐2 Cash

 Ben

efits, or FD

PIR. Yo

u only n

eed to

 provid

e one case n

umber. If yo

u particip

ate in one o

f these p

rogram

s and do not kn

ow yo

ur case n

umber, co

ntact yo

ur case w

orke

r. Med

icaid an

d Bad

gerCare case 

numbers d

o NOT q

ualify fo

r free m

ilk. 

Go to

 STEP 4. 

STEP 3: REPORT IN

COME FO

R ALL HOUSEH

OLD

 MEM

BERS How

 do I report my incom

e?  

Use th

e charts titled

 “Sources of Income for Children” an

d “Sources of Incom

e for Adults,” prin

ted on th

e back sid

e of th

e applicatio

n fo

rm, to

 determ

ine if yo

ur h

ouseh

old 

has in

come to

 report. 

Rep

ort all am

ounts in

 GROSS IN

COME O

NLY. R

eport all in

come in

 whole d

ollars. D

o not in

clude cen

ts. Gross in

come is th

e total in

come received

 befo

re taxes. Man

y peo

ple 

think o

f income as th

e amount th

ey “take home” an

d not th

e total, “gro

ss” amount. M

ake sure th

at the in

come yo

u rep

ort o

n th

is applicatio

n has N

OT b

een red

uced

 to pay 

for taxes, in

suran

ce prem

iums, o

r any o

ther am

ounts taken

 from yo

ur p

ay. 

STEP 1: LIST ALL HOUSEH

OLD

 MEM

BERS WHO ARE IN

FANTS, CH

ILDREN

, AND STU

DEN

TS UP TO

 AND IN

CLUDING GRAD

E 12 Tell u

s how m

any in

fants, ch

ildren

, and sch

ool stu

den

ts live in yo

ur h

ouseh

old. Th

ey do NOT h

ave to be related

 to yo

u to

 be a p

art of yo

ur h

ouseh

old.  

Who should I list here? W

hen

 filling o

ut th

is section, p

lease inclu

de A

LL mem

bers in

 your h

ouseh

old who are:  

Child

ren grad

es 12 or u

nder A

ND are su

pported

 with

 the h

ouseh

old’s in

come; an

d 

In yo

ur care u

nder a fo

ster arrangem

ent, o

r qualify as h

omeless, m

igrant, o

r runaw

ay youth, o

r enrolled

 in a H

ead Start p

rogram

. 

A) List each child’s name. P

rint each

 child

’s nam

e. Use o

ne lin

e of th

e applicatio

n fo

r each 

child

. When

 prin

ting n

ames, w

rite one letter 

in each

 box. Sto

p if yo

u ru

n out o

f space. If 

there are m

ore ch

ildren

 presen

t than

 lines o

n 

the ap

plicatio

n, attach

 a second piece o

f pap

er with

 all required

 inform

ation fo

r the 

additio

nal ch

ildren

. 

B) Enter the grade and the name 

of the school the child attends or mark n/a if not in school. En

ter the grad

e level of th

e studen

t in th

e ‘Grad

e’ co

lumn. 

C) Do you have any foster children? If an

y child

ren 

listed are fo

ster child

ren, m

ark the “Fo

ster Child

” box 

next to

 the ch

ildren

’s nam

es. If you are O

NLY ap

plyin

g for fo

ster child

ren, after fin

ishing STEP 1

, go to

 STEP 4. 

Foster ch

ildren

 who live w

ith yo

u m

ay count as 

mem

bers o

f your h

ouseh

old an

d sh

ould be listed

 on 

your ap

plicatio

n. If yo

u are ap

plyin

g for b

oth fo

ster an

d non‐fo

ster child

ren, go

 to step

 3.   

D) Are any children hom

eless, migrant, 

runaway or enrolled in a H

ead Start program

? If you believe an

y child

 listed in

 this sectio

n m

eets th

is descrip

tion, m

ark the “H

omeless, M

igrant, R

unaw

ay or 

Head

 Start” box n

ext to th

e child

’s nam

e an

d co

mplete all step

s of th

e applicatio

n. 

Write a “0” in any fields where there is no income to rep

ort. A

ny income fields left empty or blank will also be counted as a zero. If yo

u write ‘0

’ or leave an

y fields blank, you 

are certifying (promising) that there is no in

come to rep

ort. If local officials suspect that your household in

come was rep

orted

 incorrectly, your ap

plication will be 

investigated

. 

Mark how often

 each type of income is received using the boxes to the righ

t of each field. 

3.A. REP

ORT

 INCO

ME EA

RNED

 BY CH

ILDRE

N 

A)  R

eport a

ll income ea

rned

 or receive

d by

 children. Rep

ort the combined

 gross in

come for ALL child

ren listed

 in STE

P 1 in

 your household in

 the box marked “Child

 Income.” Only count 

foster child

ren’s personal in

come if you are applying for them together with the rest of yo

ur household. 

  Wha

t is C

hild In

come? Child

 income is m

oney received from outside yo

ur household that is paid DIREC

TLY to your child

ren. M

any households do not have any child

 income. 

3.B.  R

EPORT

 INCO

ME EA

RNED

 BY AD

ULTS 

List adu

lt ho

useh

old mem

bers’ n

ames. 

Print the nam

e of each household m

ember in

 the boxes marked “Nam

e of Adult Household M

embers (First and Last).” W

hen

 filling out this section, p

lease include ALL adult 

mem

bers in your household who are living with you and share income an

d expen

ses, even if they are not related and even if they do not receive income of their own. 

Do NOT includ

e:  

o

Peo

ple who live with you but are not supported

 by yo

ur household’s in

come AND do not contribute in

come to your household.  

o

Infants, child

ren and studen

ts alrea

dy listed in STE

P 1. 

C) Rep

ort e

arning

s from

 work. Rep

ort all total gross in

come 

(before taxes) from work in

 the “Earnings from W

ork” field on 

the ap

plication. This is usually the money received from 

working at jo

bs. If you are a self‐em

ployed business or farm

 owner, you will rep

ort your net in

come. 

  Wha

t if I am se

lf‐em

ploy

ed? Rep

ort in

come from that work as 

a net amount. This is calculated by subtracting the total 

operating expenses of yo

ur business from its gross receipts or 

revenue. 

D) R

eport incom

e from

 pub

lic assistance/child

 sup

port/alim

ony. 

Rep

ort all income that applies in the “Public Assistance/Child

 Su

pport/Alim

ony” field on the application. D

o not report the cash 

value of an

y public assistance ben

efits NOT listed on the chart. If 

income is received from child

 support or alim

ony, only rep

ort court‐

ordered

 payments. Inform

al but regu

lar paymen

ts should be 

reported

 as “other” income in the next part. 

E) Rep

ort incom

e from

 pen

sion

s/retirem

ent/all 

othe

r incom

e. Rep

ort all income that applies in 

the “Pen

sions/Retirem

ent/ All Other In

come” 

field on the ap

plication.  

F) Fluctua

ting Income.  For sea

sonal workers an

d others whose 

income fluctuates an

d usually earn m

ore m

oney in some 

months than

 others.  In these situations, project the an

nual 

rate of income an

d rep

ort that.  Th

is in

cludes workers with 

annual employm

ent contracts but may choose to have salaries 

paid over a shorter period of time; for example, school 

employees.   

 

G) R

eport total hou

seho

ld size. Enter the total n

umber of household 

mem

bers in the field “To

tal H

ousehold M

embers (Child

ren and 

Adults).” This number M

UST be equal to the number of household 

mem

bers listed in

 STE

P 1 an

d STE

P 3. If there are an

y mem

bers of 

your household that you have not listed on the application, go back 

and add them

. It is very im

portan

t to list all household m

embers, as 

the size of yo

ur household affects yo

ur eligibility for free

 milk. 

H) P

rovide

 the last fo

ur digits

 of y

our S

ocial 

Security Num

ber (SSN). An adult household 

mem

ber m

ust enter the last four digits of their 

SSN in

 the space provided

. You are eligible to 

apply for ben

efits even

 if you do not have a SSN. 

If no adult household m

embers have a SSN, lea

ve 

this space blank an

d m

ark the box to the righ

t labeled

 “Check box if no SSN

.” 

STEP

 4: C

ONTA

CT IN

FORM

ATION AND ADULT SIGNAT

URE

 An

 adu

lt mem

ber o

f the

 hou

seho

ld m

ust sign the ap

plication. By sign

ing the ap

plication, th

at hou

seho

ld m

embe

r is p

romising that all inform

ation ha

s bee

n truthfully and

 completely repo

rted

. Before completing this se

ction, please also m

ake sure you

 hav

e read

 the privacy an

d civil rights s

tatemen

ts on the ba

ck of the

 app

lication. 

A) Provide

 you

r con

tact in

form

ation. W

rite your curren

t ad

dress in

 the fields provided

 if this in

form

ation is available. If 

you have no perm

anen

t ad

dress, this does not make yo

ur 

child

ren in

eligible for free

 milk. Sharing a phone number, email 

address, o

r both is optional, b

ut helps us reach you quickly if we 

nee

d to contact you. 

B) Prin

t or s

ign yo

ur nam

e.  

The ad

ult filling out the 

application m

ust print or sign

 their nam

e in the sign

ature 

box. 

C) Return completed

 form

 to: M

aryann

 Pike, 

Waterford Union

 High 

Scho

ol, 5

07 W

. Main 

Street, W

aterford, W

I  53

185  

D) S

hare children’s racial and

 ethnic iden

tities 

(optiona

l). On the back of the ap

plication, w

e ask yo

u to 

share inform

ation about yo

ur child

ren’s race an

d 

ethnicity. This field is optional and does not affect your 

child

ren’s eligibility for free

 milk. 

 

2019-2020 Ho

useh

old

Ap

plicatio

n fo

r Free M

ilk C

omplete one ap

plication per household. Please use a pen (not a

pencil).

ST

EP

1

List A

LL

infan

ts, child

ren, an

d stu

den

ts up

to an

d in

clud

ing

grad

e 12 wh

o are H

ou

seho

ld M

emb

ers If m

ore spaces are required for additional names, attach another sheet of paper.

De

finition

of H

ou

seh

old

Me

mb

er: “A

nyo

ne

wh

o is livin

g w

ith yo

u an

d sha

res inco

me

and e

xpe

nse

s, eve

n if n

ot related

.”

Ch

ild’s F

irst Nam

e

M

I

Ch

ild’s L

ast Nam

e

Grad

e

S

chool the child attends or N

A if not in school

Fo

ster

Ch

ild H

om

ele

ss, M

igra

nt,

Ru

na

wa

y H

ea

d

Start

ST

EP

2

Do

any H

ou

seho

ld M

emb

ers (inclu

din

g yo

u) cu

rrently p

articipate in

any o

f the fo

llow

ing

assistance p

rog

rams: F

oo

dS

hare, W

-2 Cash

Ben

efits, or F

DP

IR?

Y

es / N

o

C

ase Nu

mb

er

Pro

gram

Nam

e (RE

QU

IRE

D)

If you

answ

ered N

O > C

omplete S

TE

P 3. If yo

u an

swered

YE

S >

Write a case num

ber here, then go to ST

EP

4 (Do not com

plete ST

EP

3)

W

rite only one case number in this space.

M

edicaid

and

Bad

ger C

are do

es no

t qu

alify

ST

EP

3

Rep

ort In

com

e for A

LL

Ho

useh

old

Mem

bers (skip this step if you answ

ered ‘Yes’ to S

TE

P 2)

Flip the page and revie

w the charts titled “S

ources of Income” for m

ore information.

A. C

hild

Inco

me

So

me

times ch

ildre

n in

the ho

useho

ld ea

rn in

com

e. P

lea

se in

clude

the T

OT

AL

inco

me

ea

rne

d by a

ll infa

nts, ch

ildre

n and

stud

ents u

p to an

d in

cluding

grade

12 liste

d in ST

EP

1 h

ere

.

Child incom

e

H

ow often?

Weekly

Bi-W

eekly 2x M

onth M

onthly

$

B. A

ll Ad

ult H

ou

seho

ld M

emb

ers (inclu

din

g yo

urself)

List all Household M

em

bers not listed in ST

EP

1 (including yourself) even if th

ey d

o n

ot receive in

com

e. For each H

ousehold Mem

ber listed, if they do receive income, report total g

ross incom

e (before taxes) for each source in w

hole dollars only (no cents). If they do not receive income from

any source, write ‘0’. If you enter ‘0’ or leave any fields blank, you are certifying (prom

ising) that there is no income to report.

F.

Season

al W

orkers, a

nd

oth

ers w

ith flu

ctua

ting

inco

me

, pro

ject th

e

an

nua

l incom

e an

d

rep

ort he

re.

Nam

e of Adult H

ousehold Mem

bers (F

irst and Last Nam

e)

C

.

How

often?

D. P

ublic Assistance/

Child S

upport/ A

limony/S

SI/V

A B

enefit

How

often?

E. P

ensions/Retirem

ent/ S

ocial Security,

Other Incom

e

H

ow often?

Earning

s from W

ork

Weekly

Bi-W

eekly 2x M

onth M

onthly

W

eekly B

i-Weekly

2x Month

Monthly

Weekly

Bi-W

eekly 2x M

onth M

onthly

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

G. T

otal H

ou

seho

ld M

emb

ers (C

hild

ren an

d A

du

lts)—R

EQ

UIR

ED

H. L

ast Fo

ur D

igits o

f So

cial Secu

rity Nu

mb

er (SS

N) o

f Prim

ary Wag

e E

arner o

r Oth

er Ad

ult H

ou

seho

ld M

emb

er—R

EQ

UIR

ED

or check box if no SS

N

X

X

X

X

X

C

heck b

ox if n

o S

SN

ST

EP

4

Co

ntact in

form

ation

and

adu

lt sign

ature

Retu

rn co

mp

leted fo

rm to

you

r scho

ol.

Waterford U

nion High School, 507 W

. Main Street, W

aterford, WI 53185

“I certify (promise) that all inform

ation on this application is true and that all income is reported. I understand that this inform

ation is given in connection with the receipt of F

ederal funds, and that school officials m

ay verify (check) the inform

ation. I am aw

are that if I purposely give false information, m

y children may lose m

eal benefits, and I may be prosecuted under applicable S

tate and Federal law

s.”

Street A

ddress (if available) A

pt #

City

S

tate

Zip

D

aytime P

hone and Em

ail (optional)

Printed N

ame O

R S

ignature of Adult C

ompleting this A

pplication—R

EQ

UIR

ED

Today’s D

ate Mo./D

ay/Yr.

Check all that apply

INS

TR

UC

TIO

NS

S

ou

rce

of

Inco

me

S

ou

rces o

f In

co

me f

or

Ch

ild

ren

So

urce

s of C

hild

Incom

e Ex

ample

(s)

- G

ross

ea

rnin

gs

fro

m w

ork

-

A c

hild

has

a r

egul

ar

full

or p

art

-tim

e jo

b w

he

re

the

y e

arn

a s

ala

ry o

r w

age

s

- S

oci

al S

ecu

rity

- D

isa

bilit

y p

aym

en

ts

- S

urv

ivo

r’s

bene

fits

- A

chi

ld is

blin

d or

dis

able

d an

d re

ceiv

es S

ocia

l S

ecur

ity b

enefi

ts

- A

par

ent i

s di

sabl

ed, r

etire

d, o

r dec

ease

d, a

nd t

heir

child

rece

ives

Soc

ial S

ecur

ity b

enefi

ts

- In

com

e fr

om

pe

rso

n o

uts

ide

th

e h

ouse

hold

-

A f

rien

d o

r e

xte

nde

d fa

mily

me

mb

er r

egu

larl

y g

ive

s a

ch

ild s

pend

ing

mon

ey

- In

com

e fr

om

an

y o

the

r so

urce

-

A c

hild

re

ceiv

es

reg

ula

r in

com

e fr

om

a p

riva

te

pe

nsio

n fu

nd

, an

nuity

, o

r tr

ust

So

urc

es o

f In

co

me f

or

Ad

ult

s

Earn

ings f

rom

Wor

k Pu

blic A

ssist

ance

/ Al

imon

y /

Child

Sup

port

Pens

ions /

Reti

rem

ent /

Al

l Oth

er In

com

e -

Gro

ss s

ala

ry,

wa

ge

s, c

ash

bo

nuse

s -

Ne

t in

com

e fr

om

se

lf-e

mp

loym

en

t (f

arm

o

r b

usin

ess

); F

AR

M—

refe

r to

line

18

of

Sch

edu

le 1

or

line

34

fro

m S

che

dule

F;

BU

SIN

ES

S—

refe

r to

line

12

of

Sch

edu

le 1

or

line

31

fro

m S

che

dule

C.

If y

ou

are

in th

e U

.S.

Mili

tary

: -

Ba

sic

pay

an

d c

ash

bo

nuse

s (d

o N

OT

in

clu

de c

om

ba

t pay

, F

SS

A o

r p

riva

tize

d h

ous

ing

allo

wa

nce

s)

- A

llow

an

ces

for

off-

bas

e ho

usin

g, f

ood

a

nd

clo

thin

g

- U

ne

mp

loym

en

t be

ne

fits

- W

orke

r’s c

om

pen

satio

n -

Su

pp

lem

enta

l Sec

uri

ty

Inco

me

(S

SI)

-

Ca

sh a

ssis

tan

ce fr

om

S

tate

or

loca

l go

vern

me

nt

- A

limo

ny

pa

yme

nts

-

Ch

ild s

uppo

rt p

aym

en

ts

- V

ete

ran

’s b

enefi

ts

- S

trik

e be

nefit

s

- S

oci

al S

ecu

rity

(inc

lud

ing

ra

ilroa

d re

tire

me

nt a

nd

bla

ck lu

ng b

enefi

ts)

- P

riva

te p

ensi

ons

or

dis

abi

lity

ben

efit

s -

Re

gu

lar

inco

me

fro

m t

rust

s o

r e

sta

tes

- A

nn

uiti

es

- In

vest

me

nt in

com

e

- E

arn

ed in

tere

st

- R

en

tal i

nco

me

- R

eg

ula

r ca

sh p

aym

en

ts fr

om

ou

tsid

e

ho

useh

old

O

PT

ION

AL

C

hild

ren

’s R

acia

l an

d E

thn

ic Id

enti

ties

We

are

req

uire

d to

ask

for

info

rmat

ion

abou

t yo

ur c

hild

ren’

s ra

ce a

nd e

thni

city

. T

his

info

rmat

ion

is im

port

ant a

nd

help

s to

mak

e su

re w

e ar

e fu

lly s

ervi

ng

our

com

mun

ity.

Res

pond

ing

to t

his

sect

ion

is o

ptio

nal a

nd

does

not

aff

ect

your

chi

ldre

n’s

elig

ibili

ty fo

r fr

ee o

r re

duce

d pr

ice

mea

ls.

Eth

nici

ty C

heck

one

H

ispa

nic

or L

atin

o N

ot H

ispa

nic

or L

atin

o

Rac

e C

heck

one

or m

ore

Am

eric

an I

ndia

n or

Ala

skan

Nat

ive

Asi

an

Bla

ck o

r A

fric

an A

mer

ican

N

ativ

e H

aw

aiia

n or

Oth

er P

acifi

c Is

land

er

Whi

te

The

Ric

har

d B

. Ru

ssel

l N

atio

nal

Sch

oo

l L

un

ch A

ct r

equi

res

the

info

rmat

ion

on t

his

appl

icat

ion.

You

do

not h

ave

to g

ive

the

info

rmat

ion,

but

if y

ou d

o no

t, w

e ca

nnot

app

rove

you

r ch

ild fo

r fr

ee o

r re

duce

d pr

ice

mea

ls. Y

ou m

ust i

nclu

de th

e la

st fo

ur d

igits

of t

he s

ocia

l sec

urity

num

ber

of th

e ad

ult h

ouse

hold

mem

ber

who

si

gns

the

appl

icat

ion.

The

last

four

dig

its o

f the

soc

ial s

ecur

ity n

umbe

r is

not

req

uire

d w

hen

you

appl

y on

be

half

of a

fost

er c

hild

or

you

list a

Sup

plem

enta

l Nut

ritio

n A

ssis

tanc

e P

rogr

am (

SN

AP

), T

empo

rary

A

ssis

tanc

e fo

r N

eedy

Fam

ilies

(T

AN

F)

Pro

gram

or

Foo

d D

istr

ibut

ion

Pro

gram

on

Indi

an R

eser

vatio

ns

(FD

PIR

) ca

se n

umbe

r or

oth

er F

DP

IR id

entifi

er fo

r yo

ur c

hild

or

whe

n yo

u in

dica

te th

at th

e ad

ult

hous

ehol

d m

embe

r si

gnin

g th

e ap

plic

atio

n do

es n

ot h

ave

a so

cial

sec

urity

num

ber.

We

will

use

you

r in

form

atio

n to

det

erm

ine

if yo

ur c

hild

is e

ligib

le fo

r fr

ee o

r re

duce

d pr

ice

mea

ls, a

nd fo

r ad

min

istr

atio

n an

d en

forc

emen

t of t

he lu

nch

and

brea

kfas

t pro

gram

s. W

e M

AY

sha

re y

our

elig

ibili

ty in

form

atio

n w

ith

educ

atio

n, h

ealth

, and

nut

ritio

n pr

ogra

ms

to h

elp

them

eva

luat

e, fu

nd, o

r de

term

ine

bene

fits

for

thei

r pr

ogra

ms,

aud

itors

for

prog

ram

rev

iew

s, a

nd la

w e

nfor

cem

ent o

ffic

ials

to h

elp

them

look

into

vio

latio

ns o

f pr

ogra

m r

ules

.

In a

ccor

danc

e w

ith F

eder

al c

ivil

right

s la

w a

nd U

.S. D

epar

tmen

t of A

gric

ultu

re (U

SD

A)

civi

l rig

hts

regu

latio

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Special Milk Program - Sharing Information With Other Programs Page 1

SHARING INFORMATION WITH OTHER PROGRAMS

Dear Parent/Guardian:

To save you time and effort, the information you gave on your Free Milk Application may be shared with other programs for which your children may qualify. For the following programs, we must have your permission to share your information. Sending in this form will not change whether your children get free milk.

Yes! I DO want school officials to share information from my Free Milk Application withTaher Food Service, Inc. (providerofschoollunchservicesatWaterfordUnionHighSchool)

If you checked yes to any or all of the boxes above, fill out the form below to ensure that your information is shared for the child(ren) listed below. Your information will be shared only with the programs you checked.

Child's Name: ____________________________________________________________ School: ___________________________________________________________

Child's Name: ____________________________________________________________ School: __________________________________________________________

Child's Name: ____________________________________________________________ School: __________________________________________________________

Child's Name: ____________________________________________________________ School: __________________________________________________________

Signature of Parent/Guardian: _________________________________________________________________ Date: _____________________

Printed Name: ________________________________________________________________________________________________________________________________

Address: ______________________________________________________________________________________________________________________________________

For more information, you may call Maryann Pike at (262) 534-9059, Ext. 7507 or email at mpike@waterforduhs.k12.wi.us.

Return this form to: Waterford Union High School, 507 W. Main Street, Waterford, WI 53185

USDANondiscriminationStatement

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

(2) fax: (202) 690-7442; or

(3) email: program.intake@usda.gov.

This institution is an equal opportunity provider.

This page intentionally left blank.

WATERFORD UNION HIGH SCHOOL Athletic and Activities Permission Slip 2019-2020

EMERGENCY MEDICAL INFORMATION

PRINT--CLEARLY Parent/Legal Guardian’s Full Name(s) Home # Family Physician Family Dentist Dad Cell # Mom Cell #

Dad Place of Employment/Work # Mom Place of Employment/Work #

Alternate Emergency Contact Home # Cell # Work #

REQUIRED Insurance Company Insurance Group #, ID #, or Med Asst.#: Other medical information (allergies, medications, etc.)

I hereby give my permission for the named student to practice, compete, and represent the school in WIAA/WACPC/USAPL approved sports

and/or the clubs and activities of Waterford Union High School. I have indicated all of those on the back of this form for interest. A roster provided by coaches and advisors will be considered the final roster of who is involved in the activity, club, or sport.

I attest to the fact that the named student has not been hospitalized or suffered any serious illness or injury since his/her last physical examination. I hereby authorize the employed or contracted staff of WUHS Athletic Department (i.e. coaches, athletic trainers, team physician, and/or other

assigned medical personnel) to provide athletic training services to my student-athlete. In case my child requires medical treatment or transportation to a medical facility and a parent/guardian is not available for consultation, I give

the advisors, coaches, and contracted staff of the WUHS Co-Curricular Department permission to determine the most appropriate method. Furthermore, if unable to be contacted, I authorize school personnel or PHYSICIAN(S) and HOSPITAL STAFF to treat our son/daughter as they

deem necessary in any non-life threatening emergency situation. I fully realize that the school does NOT provide primary insurance coverage and that there is an inherent risk of injury by participating in athletics. Pursuant to the requirements of the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder

(collectively known as “HIPAA”), I authorize health care providers of the student named above, including emergency medical personnel and other similarly, trained professionals that may be attending an interscholastic event or practice, to disclose/exchange essential medical information regarding the injury and treatment of this student to appropriate school district personnel such as but not limited to: Principal, Athletic and Activities Director, Athletic Trainer, Team Physician, Team Coach, Activities Advisor, Administrative Assistant to the Athletic Director, Health Technician, and/or other professional health care providers, for purposes of treatment, emergency care and injury record-keeping.

To the fullest extent permitted by law, I do hereby indemnify and hold harmless the staff of the Waterford High School, the Co-Curricular Department, entities, and other persons who act in reliance upon this authorization.

RESIDENCE INFORMATION CHECK ALL THAT APPLY:

Student’s primary residence is in WATERFORD Union High School’s Attendance Area Student’s primary residence is outside WATERFORD Union district, but student-athlete is attending through open enrollment Student attended a different high school during part of this school year and/or last school year

If so, name of school attended_______________________________________________

CO-CURRICULAR CODE

I/We have reviewed the 2019-2020 WUHS Co-Curricular CODE, THE WIAA Athletic Eligibility Bulletin and the specific club or sport rules and expectations provided by the coaches and advisors. I/We realize we are responsible for any changes made for this year by WUHS and the WIAA. I give permission for the student named to participate in the Interscholastic Athletic programs and/or clubs/activities at WUHS. I/We accept and agree to support, notify any known violations and follow all provisions as outlined, and to pay for any sport/activity clothing or equipment that is lost or damaged. Student’s Signature* Date: Parent/Legal Guardian’s Signature* Date:

*Signatures indicate agreement to code and verification that all information provided is true and accurate. We further acknowledge that by providing permission to my/our student to participate in the above referenced extracurricular activity that the school may take photographs and other reproductions of the activity and may use those reproductions in school newsletters, promotional materials, on its website, or may otherwise disseminate said photographs including identification of the student depicted. This authorization is provided not withstanding any opt-out election made with respect to student directory data.

Please turn page over to fill out all sports, clubs/activities interested in.

Student's Nam

e _______________________________________________________________ Gender _______ G

rade ______ (P

RIN

T –C

LE

AR

LY

)) L

ast

First

M

I

Primary R

esidence Address _________________________________________________________ B

irthdate _____________ P

rimary R

esidence A

ddress (Street A

ddress, City, an

d Zip C

ode) = P

arent/Legal G

uardian’s voter registration

, tax district, or driver license

WUHS ACTIVITIES, CLUBS, AND ATHLETICS

By indicating all the potential sports, clubs, and activities of interest, it allows for your name to be linked to a roster.

All rosters are not final until provided by the coaches and advisors. Check ALL WIAA/WACPC sports you plan to participate in at WUHS:

Fall: ☐Football ☐Volleyball ☐Soccer-B ☐Golf-G ☐Cross Country ☐Cheer ☐Swim-G ☐Dance ☐Tennis-G Winter: ☐Basketball-B ☐Basketball-G ☐Wrestling ☐Powerlifting ☐Gymnastics ☐Co-op Hockey ☐Swim-B ☐ Cheer ☐ Dance Spring: ☐Track ☐Golf-B ☐Softball ☐Baseball ☐Soccer-G ☐Tennis-B

Check ALL Club and Activities you plan to participate in at WUHS: ☐AFS ☐Art Club ☐Best Buddies ☐CHASE ☐Diversity ☐Drama/Theater Guild ☐E-Sports Club ☐FFA ☐Forensics ☐French Honors Club ☐Library Club ☐Madrigals ☐Mock Trial ☐Model UN ☐Musical ☐NHS ☐Robotics ☐Skills USA ☐Spanish Club ☐Student Council ☐Tri-M ☐Wally Club ☐Wolv-Tech ☐Class Officer