Meadows Circle of Friends Application 2020-21

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Please fill out this application to join Circle of Friends for the 2020-2021 school year.
*You will be paired in a group that will meet every two weeks on THURSDAYS during lunch time.
*We will notify members of additional events and opportunities.
*You will need to provide a parent email, and we will follow up for a signature.

Email *

Student's Name (first and last)/Nombre del estudiante: *

Please provide your parent or caregiver contact number./Proporcione el teléfono de su padre. *

Grade/Grado, Teacher/Maestro: *

K- Cruz

K-Parra

1-Carreno

1-Schaffner

2-Elizalde

2-Kerns

3-5 Wetmore

3-Burns

3-Figueroa

4-Self

4-Strahm

5-Griffith

5-Montano

6-Mendoza

6-Price

6-8- Carbajal

7-Aubrey

7-Rodriguez

8-Aguilar

8-Valtierra

STUDENT Date of birth/Estudiante, Fecha de Nac: *

YYYY

Address/Dirección(Por favor incluya la calle, ciudad, estado y código postal): *

Phone number/No. de teléfono: *

In case of an emergency, please give the name, phone number, and the relationship of the person who should be contacted/En caso de una emergencia, por favor ponga el nombre y el número de teléfono de la persona con la que debemos contactarnos: *

Snail Mail option - We know that for some students signing on to yet another virtual meeting may be too much. We are offering an alternative option to have a pen pal friend instead. *

I would like to opt into the non-virtual option and have a pen- pal friend.

I would like to have a friend group that I meet with virtually.

Other:

Do you have any allergies we should be aware of?/¿Tiene alguna alergia que debamos conocer? *

I want to be matched in a friendship with a student in CoF and will do my best to become true friends. I agree to see my Friend for lunch each week. I agree to treat my friends and all club members with respect and dignity. I also agree to attend chapter meetings and activities./ Yo quiero que me pongan en amistad con un estudiante de CoF y haré todo lo posible por ser verdaderos amigos. Estoy de acuerdo en ver a mi Amigo a la hora de almuerzo en la escuela cada semana. También estoy de acuerdo en asistir a las reuniones y actividades de la sección. *

I Agree (Required for Club Membership)

I Disagree (You will not be placed in a group. Please contact an officer or Advisor with questions or Concerns)

PARENT CONSENT Understanding & Agreement/ CONSENTIMIENTO Entendimiento y acuerdo- Circle of friends is an inclusion program based on creating friendships between students with and without disabilities. I understand that my child will be matched with new friends and will attend group activities scheduled (virtually until further notice) during and possibly after school hours. I understand that my child might be given social skills and disability- related information about their new CoF friend during in- service by the program advisor to support their understanding of disabilities and communication with their new friend. Circle of Friends es un programa de inclusión basado en la creación de amistades entre estudiantes con y sin discapacidad. Entiendo que mi hijo será emparejado con nuevos amigos y asistirá a las actividades grupales programadas (virtualmente hasta nuevo aviso) durante y posiblemente después del horario escolar. Entiendo que el asesor del programa puede brindarle a mi hijo habilidades sociales e información relacionada con la discapacidad sobre su nuevo amigo de CoF durante el servicio para apoyar su comprensión de las discapacidades y la comunicación con su nuevo amigo. *

I give permission for my child to participate in Circle of Friends./Le doy permiso a mi hijo a participar en “Circle of Friends”.

Required

LIABILITY/RESPONSABILIDAD-In consideration of the benefits and opportunities afforded to my child through the participation of the Circle of Friends program the undersigned parent / guardian agrees to the following:I release Circle of friends from any liability from accident, injury or illness suffered by my child at,during or in connection with any Circle of Friends activity except for any accidental injury which results or illness which results from intentional misconduct by Circle of Friends or its staff members. We will look solely to our insurance for coverage and compensation for any claims injuries or damages that may be suffered or caused by my child arising out of, or in connection with, Circle of Friends activities. I authorize Circle of Friends to obtain medical treatment for my child in the event of injury or illness in connection with a Circle of Friends activity and agree to pay any expense incurred for treatment. En consideración a los beneficios y oportunidades que se le brindan a mi hijo a través de la participación del programa Circle of Friends, el padre / tutor abajo firmante acepta lo siguiente:Liberó a Circle of Friends de cualquier responsabilidad por accidente, lesión o enfermedad sufrida por mi hijo en, durante o en conexión con cualquier actividad de Circle of Friends, excepto por cualquier lesión accidental que resulte o enfermedad que resulte de una mala conducta intencional de Circle of Friends o su los miembros del personal. Buscaremos únicamente en nuestro seguro la cobertura y compensación por cualquier reclamo, lesiones o daños que mi hijo pueda sufrir o causar que surjan de, o en conexión con, las actividades del Círculo de Amigos. Autorizo a Circle of Friends a obtener tratamiento médico para mi hijo en caso de lesión o enfermedad en relación con una actividad de Circle of Friends y aceptó pagar cualquier gasto incurrido por el tratamiento. *

I have read, understand, and agree to the liability agreement./He leído, entiendo y acepto el acuerdo de responsabilidad.

Media Release/permiso de media *

I give permission for my child to be photographed and/or filmed at any Circle of Friends activity and I understand that any photograph or videotape may be used for promotion by the Circle of Friends organization and/or Meadows Unions School. /Doy permiso para que mi hijo sea fotografiado o filmado en cualquier actividad de “Circle of Friends” y entiendo que cualquier fotografía o video puede usarse para promover a la organización “Circle of Friends” y Meadows Union School.

I do NOT give permission for my child to be photographed and/or filmed at any Circle of Friends activity and I understand that any photograph or videotape may be used for promotion by the Circle of Friends organization and/or in Meadows media platforms. NO doy permiso para que mi hijo sea fotografiado o filmado en cualquier actividad de “Circle of Friends” y entiendo que cualquier fotografía o video puede usarse para promover a la organización “Circle of Friends” y Meadows Union School.

I have read, understand and agree to the terms. (Digital Signature)/ He leído, entiendo y estoy de acuerdo con los términos. (Firma digital) *

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