SAINT ANDREW’S UPPER SCHOOL PERMISSION FORM 9TH GRADE TRIP PATHFINDER
I, _________________________________________________, herby give permission for my ( parent’s/ legal guardian’s complete name ) son/daughter, ____________________________________, to attend the Class Trip below.
I fully understand and agree to hold harmless Saint Andrew’s School, and any other person engaged by Saint Andrew’s School to act on its behalf during the Class Trip, from any and all injuries, claims, losses or liabilities which may occur to my son/ daughter during the Class Trip. I further understand that my son/ daughter will be under the supervision of Saint Andrew’s and is required to follow its rules and requirements.
__________________________________________________ Signature of Parent of Legal Guardian of Student ************************************************************* Destination of Field Trip: Pathfinder, Ellenton, Florida Date of Field Trip: Tuesday, January 14, 2014 – Friday, January 17, 2014 Time/ Periods Away From Campus: 4 days Faculty Sponsor/ Coordinator: Andy Mulligan, Tammy Friedman, Nicholas Dorn Ground Transportation will be arranged by Saint Andrew’s School for all students departing campus on January 14 at 7:15 in the morning and returning on January 17 at 4:30 in the afternoon. SAINT ANDREW’S SCHOOL STUDENT INFORMATION ACTIVITY PERMISSION / MEDICAL INFORMATION
Name of son/ daughter: _______________________________________________ Permission to Engage in Outdoor/Adventure Activities: Please check off the following activities that the student above has permission to perform:
____ Ropes Course
High Ropes: Ziplining, harnessed climbs up tires, beams, and other obstacles Low Ropes: Close to the ground team-building activity oriented stations (include tight rope/wire, rope swings)
____ Evening Bonfire with Smores ____ Outdoor team activities: fashioning lean-to’s, designing survival strategies, night
hikes, team sports (soccer, Ultimate Frisbee, football, etc.)
Medical Information: We have the medical forms families submitted at the beginning of the school year, but you are strongly encouraged to identify any new prescription medications that your son/ daughter may be taking on our trip. Please provide the reason for the prescribed meds. Medications (indicate dosage and reasons for taking): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Permission to Dispense Non-Prescription Medication The following non-prescription medications may be administered to the above mentioned student, if pertinent symptoms arise. Please check all that apply:
A Look at the Statistical Issues of Methylation Data AnalysisAlternative Network Interface Development for Smart Grid TechnologyAlternative Web Organizational Design Through Use of TabsAmiloride Inhibition of Store-Operated Calcium EntryAnalysis of IQG1 Phosphorylation Mutants in the Action ProbeAnalysis of the Metabolism of Lactic Acid through Mitochondrial Function by the Method of High-Performa
Alexander von Humboldt Scholarship, Karlsruhe University, Germany FULBRIGHT Post Doctoral Scholar, Woods Hole OceanographicInstitution WHOI, (Joint Program with U.S Geological Survey),2000-2001 Department of Geology and Geophysics, Woods Hole, MassachusettsPost Doctorate in Geology and Geophysics , Minerva Dead Sea ResearchDoctor of Science (D.Sc.) in Geology and Mineralogy, (MajorGeophysics
SAINT ANDREW’S UPPER SCHOOL