Gloucester county institute of technology



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GLOUCESTER COUNTY

INSTITUTE OF TECHNOLOGY



FRESHMAN/SOPHOMORE CLASS TRIP

Pride


Respect

Responsibility

Six Flags Great Adventure, Jackson, NJ

May 26, 2009



CODE OF CONDUCT – FRESHMAN/SOPHOMORE TRIP
At the end of the school year, the Gloucester County Institute of Technology will reward those students who meet or exceed our behavior expectation for the school year. Those students will have the opportunity to go to Six Flags Great Adventure for the day. The trip is fully approved by the Gloucester County Institute of Technology Board of Education and is therefore, subject to all school policies and regulations pertaining to school-sponsored trips and student behavior.
It is expected that the freshmen/sophomores going to Six Flags Great Adventure will have a good time. On the other hand, for the welfare of everyone concerned and for the sake and reputation of the school, as well as that of the individual pupils and teachers, certain conduct must be insisted upon. Each student will be held responsible for his/her conduct and appearance. Everyone at all times and under all conditions, is expected to act as a lady or a gentleman.
A student will be determined to be eligible for the freshman/sophomore trip if he/she has been suspension free.
A student will be determined to be ineligible for the freshman/sophomore trip if he/she has been:

a. Deemed as under the influence of alcohol or illegal drugs just before leaving

the trip.

b. Caught with illegal substances before leaving for the trip.

THE FOLLOWING GENERAL PRINCIPLES WILL BE INSISTED UPON:
1. Complete cooperation with the chaperones. Chaperones are designated by the school and will

have full charge of the students. Every student must cooperate with the chaperones to the fullest extent.


2. The purchase, possession, and/or consumption of alcoholic beverages and non-prescription drugs is prohibited for all students, regardless of age. This rule specifically prohibits the possessing or transporting, consuming, and purchasing (even where state law would permit) of any alcoholic beverages and/or non-prescription drugs at any time during the trip (All prescription and over the counter drugs must be registered with the chaperones, as per the Medical Form.)
3. Smoking is not permitted at any time.
4. Students are to respect the property of other students, chaperones, the transportation company, and the public in general.
5. Dress for the school trip should be presentable. Dress in comfortable, casual clothes, per our school dress code.
6. It is the responsibility of the parent/guardian to pick up their child upon return to the Gloucester County Institute of Technology.
7. FAILURE at any time, of any student, to follow the regulations for the trip or the authority of the chaperones will result in disciplinary action and parents will be notified.
8. Remember that you are a representative of Gloucester County Institute of Technology. Do not engage in any activity that will disgrace yourself, your family, the school or the community. Also, your behavior will be judged to help determine whether future Gloucester County Institute of Technology freshmen/sophomores will be permitted to go on their class trip.

GLOUCESTER COUNTY INSTITUTE OF TECHNOLOGY

MEDICAL INFORMATION AND AUTHORIZATION FORM

FRESHMAN/SOPHOMORE CLASS TRIP - 2OO9
apgwright:e-wing
Please supply the following information: (All data will be kept confidential.)


  1. Name of student:

2. Name of parent or guardian:

  1. Address:

Phone # Home: Business:

4. Date of last Tetanus Booster:

5. Known allergies: (i.e., Penicillin, foods, etc.)



6. History of past or present medical conditions that may affect treatment:







  1. Medical Insurance (Policy number must be listed.)

Name of Company: Type of Coverage:

Policy Number: I have no medical coverage:



  1. Family Doctor: Phone #:

Address:

In cases of medical emergency where parental contact cannot be made, I authorize the administrator in charge of this trip to act on my behalf as to medical treatment.

Signature of Parent/Guardian Date



GLOUCESTER COUNTY INSTITUTE OF TECHNOLOGY

Sewell, New Jersey 08080

POLICY ON SELF-ADMINISTRATION OF MEDICATIONS

IN SCHOOL AND ON SCHOOL-SPONSORED TRIPS

Due to the need for certain students to carry and self-administer potentially life-saving medication in school and/or on a school-sponsored trip, the following district policy will govern this:




  1. Written certification of the student’s illness, the name of the medication, dosage and time of administration and length of time medication to be taken must be provided to the school by the student’s physician. The physician will also certify, in writing, that the student is capable of and has been instructed in the proper administration of the required medication.




  1. The parent/guardian must provide to the school written authorization for the administration of the medication. The parent/guardian will also sign a statement releasing the school from any responsibility for any injury or claim that may arise as a result of the student’s self-administration of medication.


PLEASE NOTE: Request forms are available in the School Nurse’s Office for the purpose of #1 and #2.


  1. The Board of Education will inform the parent/guardian in writing that the district shall incur no liability as a result of any injury arising from the self-medication. This can be accomplished with a letter from the school explaining this policy.




  1. On a school-sponsored trip, a student may carry on his/her person an inhaler for the treatment of asthma or an insect/bee sting kit for a life-threatening allergic reaction. Otherwise, the instructor/supervisor will hold the medication for the duration of the trip, but it will be the student’s responsibility to take the medication as directed by his/her physician.




  1. Permission for medication self-administration will be effective for the school year for which it is granted and must be renewed annually.




  1. This policy will also cover any over-the-counter medication that may need to be taken on an as needed basis on school-sponsored trips.

10.10.3.7.2 POLICY ON ADMINISTRATION OF MEDICATIONS IN SCHOOL AND ON

SCHOOL-SPONSORED TRIPS/I/POLICY

Board of Education Approved 9/5/74

Revised 9/26/91, 5/30/95, 4/24/01, 7/19/01


CT292/E-Wing/NurseSec/Nurse




FRESHMAN/SOPHOMORE TRIP PERMISSION FORM
PARENTS/GUARDIANS, please sign and return this form to Mr. Wright on October 22, 2008.
I hereby grant permission for my son/daughter, to

attend the Freshman/Sophomore Class Trip to Six Flags Great Adventure to be held on May 26, 2009.

I have read the attached code of conduct and general information. I am aware that, while all reasonable disciplinary control will be exercised by the chaperones in charge, any serious infraction shall result in disciplinary action, which may include the student being sent home at the expense of the student and/or parent.

(Signature of Parent/Guardian) (Date)



STUDENT ACKNOWLEDGEMENT FORM


STUDENTS, please sign and return this form to Mr. Wright on October 22, 2008.


I have read the attached code of conduct and general information. I agree to abide by the same. I am aware that, if I am found to be in violation of any rules herein stated, I may be suspended from the trip and returned home to face disciplinary action.

(Signature of Student) (Date)



GLOUCESTER COUNTY INSTITUTE OF TECHNOLOGY

1360 Tanyard Road, Sewell, NJ 08080

Request Form for Administration of Medication to Student

Name of Student Shop/Program am / pm


To be completed by physician
Medical condition being treated:
Name of medication:
Dosage and time of administration:
Any anticipated adverse reaction or additional comment:

Is this condition life threatening (i.e. asthma or anaphylaxis) that requires the pupil to carry and self-administer the medication in school?
Yes ____ No ____
Is it necessary for the pupil to take this medication on a school-sponsored trip?
Yes ____ No ____
Note: If yes to either question, your signature below certifies that the pupil is capable of, and has been instructed in, the proper method of self-administration of this medication.
Physician’s Certification: I hereby certify that the above information is true and correct.

Physician’s Name (Print)


Signature Date



II. To be completed by parent/guardian (Please check section(s) applicable.)
____ Medication to be administered by school nurse
I give permission to the school nurse of Gloucester County Institute of Technology to administer medication to my son/daughter ___________________________ as directed by our physician. I understand that the medication must be in the original container and appropriately labeled by the pharmacy or physician.

Signature Date

(over)

____ Life threatening medication (i.e. inhaler or epinephrine) to be self-administered by child in school.



I give permission for my son/daughter ________________________ to take his/her medication in school as directed by our physician.

Signature Date

____ Medication to be self-administered by child on school-sponsored trip

I give permission for my son/daughter _____________________________ to take his/her medication while on the ______________________________ school-sponsored trip.

I understand that the medication must be in the original container and appropriately labeled by the pharmacy or physician. Except in the case of an inhaler or an insect/bee sting kit, I understand that the instructor/supervisor will hold the medication for the duration of the trip, but it will be my child’s responsibility to take the medication as directed by our physician.

Signature Date

------------------------------------------------------------------------------------------------------------------------------------------------------------

Complete only if child is administering own medication.

Indemnification/Hold Harmless Agreement

for

Student Self-Administration of Medication

We, the parents/guardians of _____________________________________ hereby acknowledge and agree that the Gloucester County Vocational-Technical School District shall incur no liability as a result of any injury arising from the self-administration of medication.

We further agree that, pursuant to N.J.S.A. 18A: 40-12.3 (d), we shall indemnify, hold harmless, and defend the Gloucester County Vocational-Technical School District, its employees and agents, from and against any and all costs, expenses (including reasonable counsel fees), liabilities, judgments, losses, damages, suits, actions, fines, penalties, claims, or demands of any kind and asserted by or on behalf of any person or entity arising out of or in any way connected with the self-administration of medication by .


Parent/Guardian Signature Date


10.10.3.7.1  REQUEST FORM FOR ADMINISTRATION OF MEDICATION TO STUDENT



Revised 7/19/01E-Wing/NurseSec/Nurse

Reminder
The TRIP PERMISSION FORM and MEDICAL INFORMATION AND AUTHORIZATION FORM SHEET must be completely filled out and turned in with FULL PAYMENT of $35.00 on Wednesday October 22, 2008 at the mandatory trip meeting.
Without the TRIP PERMISSION FORM, MEDICAL INFORMATION AND AUTHORIZATION FORM SHEET, and FULL PAYMENT your son/daughter will not be allowed to attend the Freshman/Sophomore class trip to Six flags Great Adventure on May 26, 2009.

REQUEST FORM FOR ADMINISTRATION OF MEDICATION TO STUDENT, must be turned in thirty days prior to day of the trip.

There is no extended payment deadline

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