2020 Junior Preview Day Application

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2020 Junior Preview Day Application

  • Junior Preview Day at the University of South Carolina Aiken
    Thursday, April 2, 2020


    Don’t miss out! Return your permission slip to the Counseling Office no later than March 26.
    Name _____________________________________________________________________________
    Address _____________________________________________________________________________
    _____________________________________________________________________________
    Phone (Home & Parents’ Cells) _______________________________________________________
    Parent/Guardian (s) Name (s) ______________________________________
    Emergency Contact: Name: _______________________________________  **Emergency Contact is other than your parent**
    Phone: ____________________________________________________________
    Relationship to Student: _____________________________________________


    I am aware that when I am on a school-sponsored trip I am under the jurisdiction and supervision of the trip’s chaperones and that my behavior must conform to the “Code of Student Conduct”, the school’s handbook, and reasonable instruction from the chaperones. I understand that I will be subject to appropriate disciplinary action for violations of these rules and regulations.


    Student Signature ________________________________________________________________________________


    My son/daughter has my permission to attend the above mentioned field trip. I agree that neither the school, school district, nor any person employed by the school district will be held liable for any accident involving my son/daughter or for any injuries sustained by my child. Further, I give permission to the chaperones to secure proper treatment for, and to order medications, injections, anesthesia, and/or surgery for my child as named above, if necessary.


    Parent Signature ________________________________________________________________________________

     

    Medical Information


    School Name: _______________________________________________________________________________
    Student Name: _______________________________________ 3. Birthdate/Age: ___________ / ____
    Does student have medical insurance? ________________ Yes _________ No
    Insurance Company: ________________________________________________________________________
    Policy Holder: _______________________________ Policy Number: _______________________________
    Health Considerations:_____________________________________________________________________
    Allergies: __________________________________________________________________________________
    Dietary Restrictions: ________________________________________________________________________


    A medical permission form signed by the parent/guardian is required for all medications.


    Prescription medications also require a doctor’s order. You may access the medication permission form at www.acpsd.net under the Nursing Services tab or you may get one from your school nurse.


    A parent/guardian must deliver medication in the original labeled container and the completed permission form to the school nurse prior to the field trip departure date. Deliver only the amount of medication needed for the field trip. All medications will stay in the possession of the school employee trained to assist students with medication, except for students with self-medicating or self-monitoring permission.


    Please check one of the following:
    ___ My child will NOT require medication on this trip.
    ___ My child will require medication that is already at the school.
    ___ My child will require medication that I will deliver to the school.


    It is the parent’s responsibility to notify the school nurse of any changes to this information.
    I give permission to the chaperones, physicians, and hospital to secure proper treatment for, and to order medications, injections, anesthesia, and/or surgery for my child as named above.
    Parent Signature: ________________________ Date: ____________ Relationship to Child:_______________

    Lunch will be provided. Please wear comfortable shoes.