Forms Summary Sheet for Marching Band 2012 - Oakton High ...

Oakton High School Cougar Bands 

Forms Summary Sheet for Marching Band 2012 

Please detach this portion of the Marching Band packet, fill out 

completely and turn in during either of our Marching Band 

Registration Nights, June 4 and 5, 2012 from 6:00-9:00 pm in the 

Bandroom. Please note some forms are double-sided. Thank you. 

Forms in this packet: 

Page 1 Orkney Field Trip form 

Page 2 Luggage Search Form (please choose either Part I OR Part II) 

Page 3 Driver’s Form and Early Release Form (MUST be filled out for the parent 

or other adult who will drive your child home from Orkney) 

Page 4 Early Release/Late Arrival at Orkney Form (if you will be attending Family 

Day at Orkney, please fill out the bottom portion of the form) 

Page 5 Student Rights, Photo Release and Water Activities Form 

Page 6 T-Shirt Order Form and Roommate Request Form 

Page 7-15 Field Trip Forms for Marching Competitions and Away Football Games. 

Please note that Away games are optional. Your signature on these forms does not 

obligate your child to attend Away football games. 

Page 16 (optional) Orkney Family Day Subway Dinner Order Form

ffiw" 

Date(s) of Trip 

Purpose 

Annual lnstrumental Seminar 

SUPERVISIOf[ (Check one.) 

PARENTAL AUTHORIZATION 

AI\D ACKNOWLEDGEMENT OF'RISK FOR FTELD TRIP 

(This form and an attached field hip description are required for all field hips.) 

IMPORTANT DIRECTIONS: (l) Use one form per trip, (2) Complete the school portion (top half) of form, (3) Duplicate one form 

per student, and (4) Send a copy home for parent and student signatures. 

tr Students will be directly supervised by adults on this trip at all times 

fl Students will be directly supervised by adults on this trip with the following exceptions in rooms. durinq free time 

TRANSPORTATION BEING PROVIDED (Check all that apply.) 

! walking f] School Bus flCommercial Canier 

! Leased Vehicle ! County Vehicle fl None 

DRMRS OF PRMTE OR LEASED VEHICLES (check all that appty.) 

I Student 

VEHICLETYPE (Check all that apply.) 

Ec* 

RISK RELATED (Check atl that apply.) 

flPersonal Vehicle 

flParent I Teacher or StaffMember I Other Adult 

E v*(lopassengerorless) [ suv I other 

fl Swimming Pool I Amusement or Theme Park ! 

Pupil Agreement 

Beach or Ocean 

I other 

(List activity) 

While participating in this field trip, I will accept responsibility for maintaining good conduct and appearance, and I will follow directions 

at all times. 

Signature of Student 

PARENTAL AUTTIORIZATION AND ACKNOWLEDGEMENT OF RISKS 

I understand that participation in this field trip is voluntary, that it is not required, and that it exposes my child to some risk(s). I also 

understand that the hip may include arnusement activities and that participation in any amusement activities will expose my child to some 

risk of injury or even death. I have read and understand the description ofthe field trip (attached) and authorize my child to participate in the 

planned iomponents of the field trip to the extent indicated by my signature below. I also understand that participation in the field frip will 

ilvolve activities offschool property; therefore, neither the Fairfax County School Board, or its employees and volunteers, will have any 

responsibility for the condition or use ofany nonschool property. 

PARENT PERMISSION (Check all that apply.) 

' 

I Participation in all aspects ofthis tuip. 

I Participation in all aspects of this trip, except the amusement and theme park activities. 

f] Participation in all aspects ofthis trip, except the water-related activities. 

I give permission for 

Signature ofParent 

to participate in this field trip. 

IMPORTANT NOTICE Fairfax County Public Schools (FCPS) cannot be responsible for reimbursements to parents or students of money 

submitted as advance payment (e.g., for Broadway shows, transportation, or hotels) for any fiekl trip that FCPS cancels. It is strongly 

FS-I52 (9/10) recommended that you personally review any tour company's or commercial carrier's contract, including its stated refund policies, BEFORE 

your child signs up or pays for the trip. 

Date

FIELD TRIP LUGGAGE SEARCH 

No student will be allowed to participate in the school activity 

scheduled for departure on ,20- , unless 

PART I or PART ll is completed and signed by a parent or guardian. 

PART I 

CONSENT TO SEARCH 

l, 

Print Parent's or Guardian's Name 

, give my consent to officials of Fairfax County Public 

Schools and their officially designated representatives to search the luggage of my 

chi|d,,inconnectionwiththeschoo|activityschedu|ed 

Print Student's Name 

for the above date. Also, I give my consent for any search, deemed advisable, of my child's 

lodgings while on the trip. 

P*@ D"t" 

PART II 

CERTIFICATION OF CONTENTS AND DELIVERY OF LUGGAGE 

|,,certifythat|wi||searchandde|iverthe|uggageofmy 

Print Parent's or Guardian's Name 

child, -, 

Print Studenfs Name 

and it will not contain any illegal or prohibited items. 

Also, I give my consent for any search, deemed advisable, of my child's lodgings 

including luggage, while on the trip. 

Parent's or Guardian's Signature Date 

FS-143 (8/07) 

L

ffiw" 

FIELD TRIP DRIVER'S LICENSE 

AND VEHICLE INSURANCE INFORMATION 

(required when transporting students on field trips 

in personal or leased vehicles) 

Information on the driver and the driver's liability insurance is required for all personal and leased vehicles used to transport 

students (not applicable for school bus or commercial bus drivers or vehicles). 

Date 

Destination 

Purpose 

PARTI. DRTVER 

Name 

SCHOOL PRINCIPAL APPROVAL 

Principal's Signature 

FS-142 (e/10) 

FIELD TRIP PLAN 

(to be completed by the teacher) 

Specific Trip Repeated Trip 

DRIVER AND INSURANCE INFORMATION 

(to be completed by the driver and the owner or lessee of vehicle) 

I 

Explain 

n Student ! Parent ! Teacher or Staff Member I Other 

Ooerator's License Number State -bxpratlon Llate 

I certify that the vehicle I will use for this field tip: 

I is desigrred and manufachred to transport fewer than ten passengers 

n meets Federal Motor Vehicle Safety Standards and state standards applicable to passenger car occupant protection 

" standards (at the time the vehicle was manufactured) 

! has a certified seat and seat belt for each passenger (owner- or dealer-installed seats and/or seat belts me not certified) 

Driver's Signature 

PART II.INSURANCE 

-Twner or tessee of Insured Vehicle 

Insurer 

Owne/s"or Lessee's Sigtature 

Date 

odel 

Date 

Date

Student's LastName: 

Oaklon High School Cougar Bands 

Early Release or Late Arrival Form for Orkney 

All students are expected to ride the buses to Orkney. If you have an UNUSUAL situation, which would require 

your student to arrive late to Orkney, or depart early from Orkney, you MUST adhere to the following 

procedure: 

l. Pick up a Field Trip Driver form from the band director no later than August 6. 

2. Fill out completely, sigr and retum no later than August 8. A copy will be returned to you after 

administrative approval. 

3. You must present this copy to one of the band directors BEFORE you take your child from camp. 

Please note: Parent must complete Field Trip Driver's License and Vehicle lnformation form 

Name: 

Date: 

Reason for early dismissal: 

DriverName: 

Driver Signature: 

This signature releases the band director, BBOHS, OHS and FCPS of all responsibility for the above-named 

student. 

Student Name: 

I will ride home with my parents. 

I will ride home with 

Parent Signatwe: 

Transportation Home from Orkney Bandcamp 

* If your student is driving home from Orkney with someone other than a parent or guardian, you must 

complete the Field Trip Driver's License and Vehicle Insurance Inforrration form for the adult who is driving 

your student home from Orkney. 

4

Student's Full Name: 

Student Riehts and Responsibilities 

Band camp rules and Fairfax County Public policies were explained to me in detail. 

I understand these rules and policies and will abide by them as set forth by the Band 

Director. I understand that I will be sent home and will be subject to school and 

county disciplinary procedures if I do not follow the prescribed rules and policies. 

Student Signature: Date: 

Photo Release Opt Out 

You have the right to choose if your student's photograph is published or not. If 

you want to prohibit the publication of photographs of your student in any band 

media put an X below. 

( ) Do not publish photographs of my student 

Water Activities Permission/Release 

Conditions: 

1. All swimming is done at your own risk. 

2. There are no lifeguards present at the pool. 

3. Chaperones will be atthe pool atalltimes that students are swimming. 

4. Students are not to go in the pool if there are no chaperones present. 

5. The Band Director, BBOHS, Oakton High School or FCPS are not liable for 

injury or death as a result of participation in water activities. 

Permission: 

( ) My chitd may swim in the pool under conditions specified above. 

( ) My child may not swim in the pool. 

Print Parent Name: 

Parent Signature: 

F 

'q 

Date: 

6

Student's Full Name: 

OAKTON COUGAR MARCHING BAND 

Colored T-Shirt Order Form 

o Each student must wear colored t-shirts to all marching practices, both at Orkney and at school. 

o All students need one shirt of each color. If your student has their red, green, blue, yellow and orange tshirts 

from last year, they may use them again this year. 

. If your student no longer has their t-shirts, you need to order the ones he/she may need. 

. If your student is new to marching, you need to order all five t-shirts. 

. Please indicate the size needed below. 

. Please write a separate check, made payable to BBOHS. Please write'ot-shirt order" in the memo line. 

Phone Number: 

Please circle the colors your student needs: 

Please circle your T-Shirt size: 

Red Green Blue Yellow Orange 

S M L XL )O(L XXXL 

S, M, L,XL shirts cost $4 each, XXL cost $5 each. Amount Due: $ 

Please note: If you order your t-shirts after July 1,2012, we will not be able to guarantee that you receive the 

size you ordered. 

ROOMMATE REOUEST FORM 

please state your roommate preference in the space provided. Be stue that the student you would like to room 

with is agreeable with this arrangement. 2 students per room! 

Student Name: 

Roommate Preference: 

SENIORS, if you want to be placed in a cabin, check here: 

b


AI\D ACKNOWLEDGEMENT OF'RISK FOR FIELD TRIP 

(This form and an attached field ftip description are required for all field trips.) 

IMPORTANT DIRECTIONS: (l) Use one form pertip, (2) Complete the school portion (top half) of forrn, (3) Duplicate one fonn 

per studen! and (4) Send a copy home for parent and student signatures. 

Fs-152 (9/lo) 

Purpose 

Outback Bowl 

SUPERVISIOI\ (Check one.) 

fl Students will be directly supervisedby adults on this tip at all times 

I Srudents will be directly supervised by adults on this tip with the following exceptions 

TRANSPORTATION BEING PROVIDED (Check all that applv.) 

I walking 

! Leased Vehicle 

fl School Bus 

! County Vehicle 

I 

Commercial Canier 

! None 

DRMRS OF PRMTE OR LEASED VEIIICLES (Check all thatapplv.) 

I Student lParent 

I'EHICLE TYPE (Check all that apply.) 

E C* E vutt (10 Passenger or less) 

RISK RELATED (Check all that apply.) 

I Swimmingtool fl Amusement or Theme Park f] 

! Teacher or StaffMember 

Esw 



I Personal Vehicle 

flotherAdult 



at all times. 

Sigrature of Student 

Date 

PARENTAL AI THORIZATION AND ACKNOWLEDGEMENT OF RJSKS 

I understand that participation in this field trip is voluntary, that it is not required, and that it exposes my child t9 some risk(s). I also 

understand that ttre trip inay include amusemint activitiei and that participation in any amusement activities will expose my child to some 

. 

risk of injury or even ieatlr- I have read and understand the description oi m, fteH trlp (attached) and authori":" my child to partic.ip+" q.S" 

planned components of the field trip to the extent indicated by my signature_below. I also understand that participation in the field trip will 

involve activities offschool properiy; therefore, neither the Fairfax County School Board or its employees and volunteerso will have any 

responsibility for the condition or use of any nonschool property. 

PARENT PERMISSION (Check all that applv.) 

' 

! Participation in all aspects of this hip. 

I 

! Participation in all aspects ofthis trip, except the water-related activities. 

Participation in all aspects of this trip, except the amusement and theme park activities. 


Sienature ofParent 

to participate in this field triP, 

Date 

fl ottrer 

flooer 

IMPORTANT NOTICE Fairfax County Public Schools (FCPS) cannot be responsible for reimbursements to parents or sludents of money 

submitted as advance payment (e.g., for Broadway shows, transportation, or hotelsl for any field- tri_p that FCPS cancels It is strongly 

recommended that you personaitiieview any toui company's oi commercial csrriir's coniract, Ucluding its stated refund policies, BEFoRE 


o1

ffiw" 

IMpORTANT DIRECTIONS: (1) Use one form per trip, (2) Complete the school portion (top half) of fonn, (3) Duplicate one form 


fl 

I 

SUPERVISION (Check one.) 

PARENTAL AUTIIORIZATION 

AND ACKNOWLEDGEMENT OF RISK FOR FIELD TRIP 

(This form and an aftached field tip description are required for all field trips.) 

Stud.ntr will be directly supervised by adults on this trip at all times 

Students will be directly supervised by adults on this trip with the following exceptions 

TRANSPORTATION BEING PRO\TDED (check allthat 

apply.) 

! Walking 

fl Leased Vehicle 

fl School Bus 

I County Vehicle 

DRIVERS OF PRIVATE OR LEASED VEIIICLES 

! Commercial Canier 

fl None 

(Check all that apply.) 


I Teacher or StaffMember 

fl Student flParent f]OtherAdult 

VEHICLE TYPE (Check all that apply.) 

flc* Elvuo (10 passenger or less)' fl SUV 


I Swimming Pool f] Amusement or Theme Park ! 




While participating in this field t'ip, I will accept responsibility for maintaining good conduct and appearance, and I will follow directions 

at all times. 

Simature of Student 

Date 

PARENTAL AUTHORIZATTON AND ACKNOWLEDGEMENT OF RISKS 


ona"trt-a tnut Oe trlp inay include amusemint activitiei and that participation in any amusement aclivrti3s yill expose ctti|f to s^oTe,, 

3f 

riskofinjuryorevenieatb- Ihavereadandunderstandthedescriptionof'\gfreldtrip(attached)andauthori'Fmychildtoparticrpatem.tne 

pf*".aloroponents of the field tip to the extent indicated by my signaturebelow. I also understand that participation in the.field tip will 

involve activities offschool property; therefore, neither the Fairfax County School Board, or its employees and volunteers, will have any 



E Participation in all aspects ofthis tip. 

! farLicipation in all aspects of this trip, except the amusement and theme park activities, 

n Participation in all aspects ofthis kip, except the water-related activities. 

I give pemrission for 

flottrer 

flotler 

to participate in this field tiP. 

IMPORTANT NOTICE f,.airfar county pubtic schools (FCPS) cannot be responsible for reimbursements to parents or students of money 

submitted as advance payment (e.g., for Broadway shows, transportation, or hbteb) for any field trip that FCPS cancels. It is strongly 

FS-l 52 (9/10) recommended tbat you plrsonaily-rwiew any toui company's oi commcrcial carriir's conirac! including its statcd refund policies' BEFoRE 

your child signs up or Pays for the trip. 

f'8

Emw" AIID ACKNOWLEDGEMENT OF RISK FOR FIELD TRIP 


(This form and an attached field trip description are required for all field tips.) 

IMpORTANT.DIRECTIONS: (l) Use one form per trip, (2) Complete the school portion (top half) of form, (3) Duplicate one form 


fl 

! 


St.td.ntt wiil be directly supervised by adults on this hip at all times 

Students will be directly supervised by adults on this trip with the following exceptions 

TRANSPORTATIONBEING 

PROVIDED (Check all that apply.) 

I walking 

I Leased Vehicle 

fl school nus 

fl County Vehicle 

! Commercial Canier 

!None 

DRMRS OF PRMTE OR LEASED VEHICLES (Check all that applv.) 

I Student ! Parent 


fl Car n 


Vuo (10 passenger or less) 

f] 

Teacher or StaffMember 

flsw 

fl Swimmingtool ! Amusernent or Theme Park ! Beach or Ocean 


fl Personal Vehicle 

! OtherAdult 

(List acfivry 

While participating in this field rip, I will accept responsibility for maintaining good conduct and appearance, and I will follow directions 

at all times. 


Date 

PARENTAL AUTHORIZATION AND ACKNOWLEDGEMENT OF RISKS 


understand that ttt" tlp .uy include amusemint activitiei and that participation in any amusement activities will exp9s9 

Py 

child to some 

, 

rltt ori"jury o. i.utlr. I have read and understand the descripiion oitne neta trip (attached) and authorize my child to participuj" h.S. 

pil;il;p"nents "u"n of the field tip to the extent indicated by myiignature below. I also understand that participation in the.field bip will 




E Participation in all aspects ofthis trip. 

! Participation in all aspects of this trip, except the amusement and theme park activities. 

I farticipation in all aspects ofthis tip, except the water-related activities. 


Simature of Parent 


Date 

I otter 

flottrer 

IMPORTANT NOTICE Fairfax county public schools @cPS) cannot be responsible for rqimbursements to parents or students of money 

*U.ittJ * payment (e.g., for Broadway shows, transportation, or hotels) for any field trip that FCPS cancels' It is strongly 

FS-152 (9/10) recommended "O"ance that you personaily-review any tour company's oi commercial carrier's coniract, iucluding its stated refund policies, BEFoRE 


q

ffi" 

PARENTAL AUTI{ORIZATION 


(This form and an attached field trip description are required for all field trips.) 


per studen! and (4) Send a copy home for parent and student signatures' 

FS-r52 (9/10) 


fl Stuaents will be directly supervised by adults on this tip at all times 

tr Students will be directly supervised by adults on this trip with the following exceptions 

TRANSPORTATION BEING PROVIDED (Check all that applv') 

! watting 


fl Commercial Carrier 

I None 

DRIVERS OF PRIVATE OR LEASED VEHICLES (Check all that apply.) 

I Student I Parent I Teacher or Staff Member f] 

VEHICLE TYPE (Check all that applv.) 

E] c. E v* (10 passenger or less)' n suv 

RISK RELATED (Check all that applv.) 

! SwimmingPool I Amusement or Theme Park I 




other Adult 


While participating in this field rip, I will accept responsibility for maintaining good conduct and appearance, and I will follow directions 

at all times. 


PARENTALAUfHoRIZATIoNANDACKNoWLEDGEMENToFRISKS 


understand that thi trip may include amusemint activities and that participltiol h amus"Fe_nt activities will expose my 

-y 

"hilg 1o::T-, 

risk of injury or even ieatlr- I have read and understand the description of the field trip (attached) an$ my child to particrpltt t-S" 

rythorizg 

ti;;J;;p"nents of the field t'ip to the extent indicated by rignutur"_t9low. I alio understand that participation in the-freld tip will 

involve activities offschool properiy; therefore, neither the Fairfax -y County School Board, or its employees and volunteers, will have any 



! Participation in all aspects of this tip. 

I 


I participation in all aspects ofthis trip, except the water-related activities. 


Sisrature ofParent 

fl School Bus 

I County Vehicle 

Date 

! otner 

I omer 


IMPORTANT NOTICE Fairfax County Public Schools @CPS) cannot be responsible for rqimbursements to parents or students of money 

submitted as advance payment (e.g., for-Broadway shows, traniportation, or hotels) for any field trip that FCPS ca-ncels' It is strongly 

recommended that you personally review any tour compsny's oi commercial carriir's coniract, including its stated refund policies' BEFoRE 


IO

ffi 



(This form and an attached field fip description are required for all field hips.) 

IMPORTANT.DIRECTIONS: (l) Use one form per tip, (2) Complete the school portion (top half) of form, (3) Duplicate one fonn 

per student, and (4) Send a copy home for parent and student siguatures. 

SUPERVISIOfTI (Check one.) 

fl Stuaents witl be directly supervised by adults on this trip at all times 


TRANSPORTATION BEING PROVIDED (check all that applv.) 

flwatting 


fl school Bus 


! Commercial Carrier 

! None 

DRIVERS OF PRMTE OR LEASED VEHICLES (check all that applv.) 


E Student ! Parent f] Teacher or StaffMember I otherAdult 

\|EIIICLE TYPE (Check all that apply.) 

E c* fl v- (lo passenger or less) n SW 

RISK RELATED (Check all that apply ) 

I SwimmingPool I Amusement or Theme Park ! 




While participating in this field aip, I will accept responsibility for maintaining good conduct and appearance, aud I will follow directions 

at all times. 




understand that the tip may include amusemint activitiei and that participation in any amuseme* aclivrti-es ytll expose my child to some 

. 

,irt of ioi*y or even ieatlr- I have read and understand the description oittt" fi.ld ttip (attached) and authorize my,chil.d t9 participate in 

lhe 

planned of the field tip to the extent indicated by my signature below. I also understand that participation in the.field tip will 

involve activities "ornponents offschool p.op".iy; therefore, neither the Fairfax County School Board" or its employees and volunteers, will have any 


PARENT PERI\{ISSION (Check all that apply.) 

fl ta*icipation in all aspects of this tip' 

n 


E Participation in all aspects ofthis tip, except tlle water-related activities. 



to participate in this field triP. 

Date 

! ottrer 

fl otner 


submitted as advance payment (e-g,, for Broadway shows, traniportation, or hotets; for any field trip that FCPS cancels. It is strongly 

FS-152 (9/10) recommended that you personally review any toui company's oi commercial carrier's coniract, iocluding its stated refund policies' BEFoRE 


il

TAIREAX 

couNTv 

B&u*ffi's 



(This form and an attached field hip description are required for all field hips.) 



SUPERVISIOf.{ (Check one.) 

fl Srudents wili be directly supervised by adults on this trip at all times 

D Students will be directly supervised by adults on this trip with the following exceptions 


I watting 

fl Leased Vehicle 

fl School Bus 


! Commercial Carrier 

!None 

DRMRS OF PRMTE OR LEASED VEIIICLES (Check all that applv.) 

! Personal Vehicle 

! Student ! Parent I Teacher or StaffMember ! otherAdult 


E c- [ 


v* (10 passenger or less) f] SW 

fl Swimming fool I Amusement or Theme Park I 





at all times. 


Date 

PARENTAL AUTIIORIZATION AND ACKNOWLEDGEMENT OF RISKS 


u'derstand that tt. tip 111uy include amusemlnt activitiei and that participation in any amusement activities will expose my child to some 

- 

riskofinjuryor.u"rri"uth. Ihavereadandunderstandthedescriptionoithefi"ldtrip(attached)andauthori"fmy:hildtgp*:jl"J",qS' 

planned components of the field h.ip to the extent indicated by my sigrature below. I also understand that participation in the-tield frtp wrll 

involve activlties offschool property; therefore, neither the Fairfax County School Board, or its employees and volunteers, will have any 

responsibility for the condition or use of any nonschool propedry. 


E Participation in all aspects of this tip. 

! Participation in all aspects of this tip, except the amusement and theme park activities. 

n Participation in all aspects ofthis trip, except the water-related activities. 



! ottrer 

I other 

to participate in this field triP. 

IMPORTANT NOTICE Fairfax Cotrnty public schools (FCPS) ceniot be responsible for reimbursements to parents or students of money 

submitted as advance payment (e.g., for Broadway shows, transportation, or hotels) for any lield- tri_p that FCPS cancels' It is strongly 

Fs-152 (9/10) recommended that you personally review any toui company's oi commercial carrier's coiriract, including its stated refund policies' BEFoRE 


n'

ffiffi- 



(This form and an attached field trip description are required for all field trips.) 

IMpORTANT DIRECTIONS: (1) Use one form per trip, (2) Complete the school portion (top half) of fonn, (3) Duplicate one form 

per studen! and (4) Send a copy home for parent and shrdent signatures. 


fl Students will be directly supervised by adults on this trip at all times 



fl wattcing fl School Bus ! 

! Leased Vehicle f] County Vehicle ! None 

DRMRS OF PRMTE OR LEASED VEIIICLES (Check all that applv.) 

n Student fl Parenl I 

VEIIICLE TYPE (Check all that apply.) 

D c* n v^ (10 passenger or less) fl sW 

RISK RELATED (Check ail that apply.) 

Commerbial Canier 


I SwimrningPool I Amusement or Theme Park I Beach or Ocean 


! Personal Vehicle 

E OtherAdult 


While participating in this field h.ip, I will accept responsibility for maintaining good conduct and appearance, and I will follow directions 

at all times. 

Sienature of Shrdent 

PARENTAL AUTEORIZATION AND ACKNOWLEDGEMENT OF RISKS 

I understand that participation in this field trip is voluntary, that it is not required" and that it exposes nf 

thild 19 

some risk(s). I also 

understand that G Up i"uy include amusemint activitiei and that participation in any amusement activities will expose my child to some 

. 

risk of injury or even ieatb- I have read and understand the description oittre fi"ld trip (attached) an{ 

rythorizg 

my child t9 participate in 

l}e 

;l;;d;p"nents of the field trip to the extent indicated by myiignature below. I also understand that participation in the.field tip will 


responsibility for the condition or use ofany nonschool properlry. 


I Participation in all aspects ofthis trip. 

fl 


! larticipation in all aspects ofthis tip, except the water-related activities. 



Date 

flother 

! ottrer 



submitted as advance payment (e.g., for Broadway shows, transportation, or hotels) for any field trip that FCPS cancels. It is strongly 

FS-l 52 (9/10) recommended that you personally review any toui company's oi commercial carriir's coniract, including its stated refund policies' BEFoR'E 


IA




IMpORTANT DIRECTIONS: (l) Use one form per trip, (2) Complete the school portion (top half) of form, (3) Duplicate one forrn 

per studenl and (4) Send a copy home for parent and student signatures' 

fl 

fl 

FS-1s2 (9/10) 

ffi" 

SUPERVISIOITI (Check one.) 

Stuaents will be directly supervised by adults on this tip at alt times 

Students will be directly supervised by adults on this tip with the following exceptions 


I wdt

PARENTAL AUTI{ORIZATION 

AND ACKNOWLEDGF"MENT OF RISK FOR FIELD TRIP 


IMPORTANT DIRECTIONS: (l) Use one form per trip, (2) Complete the school portion (top halfl of form, (3) Duplicate one fomt 


FS-r52 (9/10) 

SUPERVISIOfTI (Check one.) 

M Students wili be directly supervised by adults on this trip at all times 

I Students will be directly supervised byadults 

on this trip with the following exceptions 

TRANSPORTATION BEING PROVIDED (check allthat 

apply.) 

! watting 


fl School nus 


DRIVERS OF PRIVATE OR LEASED VEItrCLES 

I Student I Parent 


f] 

INone 

(Check all that apply.) 

EC* flVanltopassengerorless) f]SW 

RISK RELATED (Check all that apply ) 

I SwimmingPool I Amusement or Theme Park I 

I 


Commercial Canier 




I OtherAdult 


While participating in this field h.ip, I will accept responsibility for maintaining good conduct and appearance, and I will follow directions 

at all times. 


Date 



'nderstand that the trip may include amusement activitiei and that participition in any amusement activities will expose my child to some , 

.irf.ofinjutyorevenieattr- Ihavereadandunderstandthedescripiiono?'th"fi"ldtrip(attached)an$lttrorizg.myctrildt9n{rjjpTtq.+' 

p1*"a components of the field tip to the extent indicated by myiigrrature below. I ilso understand that participation in the.field trip will 




' 

I tarticipation in all aspects of this trip. 

! Participation in all aspects of this trip, except the amusement and theme park activities. 

I Participation in all aspects ofthis tip, except the water'related activities. 


Sienature ofParent 

to participate in this field triP, 

Date 

flottrer 

! ottrer 


submitted as ldvance payment (e.g., for-Broadway shows, transportation, or hotels; for any field trip that FCPS calcels. It is strongly 

recommended that you personally review any tour company's oi commercial carrier's coniract' including its stated refrrnd policies, BEFORE 


l6

StudentName: 

Dinner Order Fundraiser 

Orkney Family Day 

Saturday, August 18, 2012 

Because we are not eating dinner in tbs dining hall on Saturday, atl parents are invited to picnic 

with their students on the glounds during the time betwem the field show and the concert. For 

those students, pare,lrts, and staffmenbers who would like to have apicnic meal provide4 

BBOHS will offer, as a firndrais€tr, to take orders for a Subway meal. The meal will consist of a 

foot-long zub sandwich, chips, and a drink and the cost is $7.00. 

For planning purposes, please circle your choice below and zubmit this form. 

Yes, I would like to order Subway. Entgrnumber of meals: 

Black Forest Ham 

Cold Cut Combo 

Veggie 

TotalNumberof Meals 

No, my dinner will be provided by my parents on Family Day 

If you circled *Yes," zubmit a SEPARATE check to BBOHS for the total by JuIy 15 (Please 

put 

SUBWAY on the memo line).

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