June
21st
–
July
22nd



2010 GHS Summer Fun and Fitness Registration
Form


Sponsored
by:
Gaston
Jr.
/Sr.
High
School
•
Location:
Gaston
High
School

 
 One
person
per
registration
form,
extra
copies
available
in
the
high
school
office
 
 Name_______________________________________________________


Parent/Guardian:
_______________________________________________
 Address__________________________________________________________________________________________________________________________
 City
____________________________________________
St
_________________________________
ZIP
_________________________________________

 E‐mail
(please
print)
_______________________
Home
Phone
_________________________
Cell
Phone:
______________________________
 Special
Needs
&
Accommodations:
____________________________________________________________________________________________
 Food
Allergies:
__________________________________________________________________________________________________________________
 Medical
Conditions/Current
Medications
student
is
taking:
________________________________________________________________
 


By
signing
below,
participants
and
parent/guardians
understand
that
photographs
and/or
videos
may
be
 taken
during
the
sessions
and
may
be
used
in
future
support
of
the
program.
By
signing
below,
 participant
and
parent/guardian
recognizes
that
there
is
risk
involved
in
any
athletic
event
and
takes
 responsibility
for
any
action
or
injury
that
may
result
through
participation.
 
 Signature
of
Parent/Guardian:
__________________________
 Signature
of
Participant:
____________________________
 


GHS Summer Fun and Fitness will
typically
run
Monday
through
Thursday
from
10:00
 a.m.
to
2:00
p.m.
June
21‐July
22
(there
is
no
camp
scheduled
the
week
of
July
5th
 through
July
9th)
with
the
exception
of
days
when
students
will
be
participating
in
field
 trips.

Students
will
not
be
required
to
attend
the
full
four
hour
regularly
scheduled
sessions,
 but
will
be
required
to
sign
in
and
out
so
parents
can
monitor
student
participation.


 *Lunch
will
be
provided
 


Daily
activities
include,
but
will
not
be
limited
to
the
following:
Regularly
scheduled
computer
 access,
basketball,
Frisbee
golf,
ultimate
Frisbee,
bike
riding,
soccer,
volleyball,
weight
lifting
programs,
 arts
and
crafts,
foreign
films,
etc.
Register
for
activities
by
filling
out
the
back
of
this
form.
 
 At
this
time,
the
Summer
Fun
and
Fitness
is
grant
funded
and
is
therefore
available
to
students
free
of
 cost.

This
is
a
great
opportunity
for
students
to
maintain
an
active
lifestyle
while
experiencing
the
joys
of
 education
in
new
and
fun
exciting
ways.
 
 If
you
have
any
questions
about
the
summer
program,
please
contact:
 
 Maddy
Anderson
 [email protected]
 
 
 503‐985‐7516
 Reeve
Woodward
 [email protected]
 
 503‐985‐7516
 
 We
look
forward
to
a
great
summer!
 
 Signature
Parent/Guardian:
___________________________________

 Date:
___________________________________________
 
 
 





Summer
Field
Trip
&
Event
Schedule
 


Below
is
a
schedule
of
afternoon
activities
and
field
trips
participants
will
have
the
opportunity
to
take
 part
in
throughout
the
summer.

Please
place
a
check
next
to
the
field
trips
you
would
like
to
participate
 in
so
that
we
can
get
an
idea
of
how
many
students
to
plan
for.

Please
note
that
spaces
for
field
trips
 are
limited
and
priority
will
be
given
to
students
who
are
regular
program
participants.







OMSI


June
24


9:00
a.m.
­
4:30
p.m.


Place
a
√
if
you
plan
to
 participate
 


Bowling


June
29


10:00
a.m.
–
2:00
p.m.





Evergreen
Aviation
Museum
&
 IMAX
 Clackamas
Aquatic
Center


July
1


9:00
a.m.
–
4:00
p.m.





July
14


10:00
a.m.
–
4:30
p.m.





Zoo


July
15


9:00
a.m.
­4:30
p.m.





Hagg
Lake
Bike
Trip
 *Students
will
need
to
provide
 their
own
bike
 Beach
Trip


July
20


10:00
a.m.
–
4:00
p.m.





July

22


9:00
a.m.
–
4:30
p.m.





•




Event


Date


Approximate
Time
Schedule



 Please
note
that
times
are
approximate
and
more
details
will
be
provided
after
registration.


Summer
Arts
&
Crafts
Schedule
 


Please
use
the
following
table
to
sign
up
for
art
activities
you
are
interested
and
available
to
participate
 in.

Please
keep
in
mind,
instructor
will
need
to
prepare
materials
in
advance
so
do
not
sign
up
unless
you
 plan
to
attend.
 
 


Activities


Date


Approximate
Time
Schedule


Summer
Jewelry
 Beading
 Stamp
Carving
with
Chinese
 Caricatures

 Knotted
Necklaces,
Bracelets,
 &

 Key­chains
 Handmade
Scrapbook
style
 Cards
&
Calligraphy


Tuesday,
June
24


10:00
a.m.
–
12:00
p.m.


Place
a
√
if
you
plan
to
 participate
 


Wednesday,
June
25


10:00
a.m.
–
12:00
p.m.





Tuesday,
July
13


10:00
a.m.
–
12:00
p.m.





July
14


10:00
a.m.
–
12:00
p.m.






 


Foreign
Film
and
Food
Schedule
 


If
enough
interest
is
generated,
we
would
also
like
to
offer
exposure
to
foreign
films
and
foods
associated
 with
regions
the
films
are
filmed.

Film
showings
will
take
place
during
the
art
time
we
have
available
so
 students
can
partake
in
a
variety
of
multicultural
activities.

Please
preview
the
movie
titles
below
and
 sign
up
for
any
you
are
interested
and
able
to
attend.

Please
keep
in
mind
once
again
that
in
order
to
 prepare
the
appropriate
amount
of
food,
we
will
need
to
know
in
advance
what
days
you
plan
to
attend.

 
 Film
Title





Date


Approximate
Time
Schedule


Offside


Tuesday,
June
22


10:00
a.m.
–
12:00
p.m.


Place
a
√
if
you
plan
to
 participate
 


Crouching
Tiger,
Hidden
 Dragon
 The
Class


Wednesday,
June
25


10:00
a.m.
–
12:00
p.m.





Tuesday,
July
13


10:00
a.m.
–
12:00
p.m.





Il
Postino



Wednesday,
July
21


10:00
a.m.
–
12:00
p.m.





PARTICIPATION AUTHORIZATION FORM 


Activity: GHS Summer Fun and Fitness Program Student Name___________________________Address_______________________________________________ Parent(s)
/
Guardian(s)
Name(s)______________________________________Phone(H)_________(W)_________
 Person
other
than
you
to
notify
in
case
of
emergency________________________________
Phone_____________
 Family
Doctor_______________________________________________________________Phone_____________
 


The undersigned, the parents / legal guardians of____________________________________________ , request that he /she be allowed to participate in the above named program beginning June 21st and ending July 22nd. And in doing so, assume all the responsibility and risk for injuries that may be incurred as a result of his or her participation in the activity. ________________________________ is also assured by the undersigned that the above-named student is properly insured against such injuries by the following insurance company. NAME OF INSURANCE COMPANY & POLICY NUMBER___________________________________________ PARENTS / GUARDIANS CONSENT Release/Hold Harmless The undersigned, the parent(s) / legal guardian(s) of_______________________________, give our consent for him / her to participate in _____________________________________ approved activities, and to go on any trips in connection with this participation. We agree that in the event of the school’s inability to contact us in an emergency situation, a licensed physician may take such action as is deemed necessary and proper to treat our child. We are aware of the standards which our son / daughter is expected to uphold, and we understand that participation in GHS Summer Fun and Fitness activities is a privilege which depends on our child’s upholding those physical, moral, personal, and academic standards. I/we hereby release and hold harmless Gaston Jr./Sr. High School, its officers, employees and agents from liability from any and all claims including the negligence of its volunteers, officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, my child/ward participating in this program. Assumption of Risks: Participation in these programs carry with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises and sprains to 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks and concussions to 3) catastrophic injuries including paralysis and death. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in school programs. I hereby assert that my child/ward’s participation is voluntary and that I/we knowingly assume all such risks. 


Acknowledgment of Understanding: I/we have read the release/hold harmless and assumption of risk above, understand its terms, and understand that I/we am giving up substantial rights, including my/our right to sue. I/we acknowledge that I/we am/are signing the agreement freely and voluntarily, and intend by my/our signature(s) to be a complete and unconditional release of all liability to the greatest extent allowed by law. I/we am/are the parent(s)/guardian(s) of the minor ________________________________ and am/are signing this release on behalf of said minor. Signature of Parent/Guardian of Minor: ______________________________________ Date: ____________ Signature of Parent/Guardian of Minor: ______________________________________ Date: ____________ Signature of Minor: ______________________________________________________ Date: ____________