Concord Middle School Community • Achievement • Lifelong Learning ____________________________________________________________ 835 Old Marlboro Road
Concord, MA 01742
Phone: 978.318.1380
Fax: 978-318-1392 Dear CMS Music Parents, Plans are underway for the middle school students to participate in the Music In The Parks Festival on Saturday May 16th, 2015. Students will travel to Holyoke High School to perform, followed by an afternoon at Six Flags New England in Agawam. This festival will allow students to receive written and recorded comments from accomplished choral and instrumental conductors. These comments will help the groups to focus and and improve for our spring concert season. Last year’s experience proved to be very rewarding and educationally motivating for all students who attended. The accomplishments of last year provide a high standard for us to match or beat. The cost for this experience is $70 per student, which includes transportation, entrance to the park, and a T-shirt. This cost does not include lunch and dinner, more details will be announced about what to bring on the trip in the coming weeks. We ask that students arrive at 6:30am sharp to allow us to take attendance and depart on time. Following their festival performance, students will be transported to the Six Flags Park and return to Sanborn at approximately 9:00pm. A specific schedule and instructions will be distributed prior to the trip. Please complete the attached permission slip and return it with a check made out to “Concord Middle School” by Monday April 13th. Should you have any questions regarding the trip or any other concerns, please feel free to email your child’s music teacher. Sincerely, The CMS Music Department Do you plan on participating in the Music in the Parks Field Trip? If we do not have enough students (certain instruments or voice parts), there is a chance that some groups may not be able to attend this festival. ⬜No thank you. Student Name______________________ ⬜Yes!
Parent Signature____________________ If no, please turn in just this page. If yes, please turn in the following three forms and a $70 check made payable to “Concord Middle School.” Forms are due by Monday April 13th. Music Festival Permission/Emergency Slip Student’s Name:__________________________________Homeroom:__________________ I, the undersigned parent/guardian of ______________________________ (student name), a minor, do hereby consent to my child's participation on the Concord Middle School field trip to the Music in the Parks Festival at Holyoke High School, Holyoke MA, and Six Flags New England, Agawam MA, on Saturday May 16th, 2015. I affirm that I have read this Consent and Release Form and that I understand the contents of this Form. I understand that my child's participation in this program is voluntary and that my child and I are free to choose not to participate in said program. By signing this Form, I affirm that I have decided to allow my child to participate in the Music in the Parks field trip with full knowledge that the Releases (Concord Middle School, Mr. Rivenburgh, Ms. Anderson and all chaperones) will not be liable to anyone for personal injuries and property damage he/she may suffer in activities on this field trip. Photo Release: I understand that photos of my child from this festival will be posted on the CMS Music websites and the school district website. Student names will not be posted with these photos. Signed: ______________________________________ Date: __________________ (Parent Signature) Please enclose a check made out to “Concord Middle School” for $70 Financial Aid Donation: If you would like to make a voluntary contribution toward the scholarship fund for this trip, please indicate your contribution amount here _________________ and add the amount to your check. Thank you for your contribution. Financial Aid Request: If you need financial aid for this trip please check off next to the amount you are able to pay. Your request will be forwarded to the Principal: I am able to pay ⬜$53.00
⬜$35.00
⬜Other:______ Student Name:_____________________________________ Students will be separated into groups while in the amusement park. Students must stay with their group at all times. Please indicate whether or not you would like your child with a chaperone at all times
. Students that are without a chaperone will still need to check in with an adult several times throughout the afternoon. Even if you check “un-chaperoned” your child may still need to be chaperoned based on the needs of our group. I would like to have my child with a (Please Check One): ___Chaperoned group ___Un-chaperoned group Signed: ______________________________________ Date: __________________ (Parent Signature) Would you like to Chaperone? (Please Check One): ____Yes I am interested in chaperoning this field trip ___No Thanks! If yes, your email:__________________________________ Checking yes does not guarantee that you are chaperoning, we will contact chaperones as needed, thank you. If you are interested in chaperoning the trip please check with Vanessa Moran ([email protected]) to make sure you have a current CORI form on file. If you do not have a CORI form on file please be sure to fill one out ASAP. You must do so in person in the main office of either Sanborn or Peabody. T-Shirt Size: Please check one (all T-shirts will be in adult sizes) ⬜Small ⬜Medium ⬜Large ⬜Extra Large Medical Information Authorization for a school Representative to Act on Behalf of an Absent Parent or Guardian: As parent/guardian, I delegate authority to Daniel Rivenburgh, Chris Noce, Paul Halpainy, and/or Anna Anderson to act in my absence to ensure my son/daughter, will receive emergency medical attention if the need arises. If however, in the opinion of competent medical personnel there is sufficient time and need to contact me, every effort will be made to do so. Signed: ______________________________________ Date: __________________ Parent/Guardian Name(s)_____________________________________________ Home Telephone______________________________________________ Work or Cell Phone(s)__________________________________________ If I/we cannot be reached and an emergency occurs, please contact: Emergency Contact Name: _________________________________________________ Relationship to Student:____________________________________________________ Home Phone__________________________Cell Phone__________________________ Student’s Physician: __________________________ Telephone:___________________ Medical Insurance Co.:________________________Policy Number:________________ Allergies: _______________________________________________________________ Does your child have an Epi-Pen prescribed for these allergies?
Yes /
No (It is recommended that students carry their own epi-pens, but the chaperone should also have an epi-pen available and must be trained in epi-pen administration) Does your child carry an inhaler? Yes
/
No If yes, please sign below. I give permission for my child to carry and self-administer their inhaler. Signature_____________________________________________ Are there any conditions for which this student is currently receiving treatment and/or medication? If so, list medications: ⬜ I/we wish to have a chaperone hold and dispense medications with the following instructions: *Please use the back of this form to include other pertinent information*